Artikel
Complex renal cell carcinoma can be safely cured via an open nephron sparing approach
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Autoren
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Hanna-Elisa Spohn
- Department of Urology, University of Cologne Faculty of Medicine and University Hospital Cologne, Cologne, Germany
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Pia Paffenholz
- Department of Urology, University of Cologne Faculty of Medicine and University Hospital Cologne, Cologne, Germany
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Nele Gutjahr
- Department of Urology, University of Cologne Faculty of Medicine and University Hospital Cologne, Cologne, Germany
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Yael Hamensa
- Department of Urology, University of Cologne Faculty of Medicine and University Hospital Cologne, Cologne, Germany
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Christina Steinbach
- Department of Urology, University of Cologne Faculty of Medicine and University Hospital Cologne, Cologne, Germany
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David Pfister
- Department of Urology, University of Cologne Faculty of Medicine and University Hospital Cologne, Cologne, Germany
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Axel Heidenreich
- Department of Urology, University of Cologne Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| Veröffentlicht: | 28. März 2023 |
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Gliederung
Text
Introduction: Oncological and perioperative outcome of robotic-assisted or open partial nephrectomy (PN) and radical nephrectomy (RN) in renal cell carcinoma have been intensively discussed.
Material and methods: We performed a retrospective analysis including 142 renal cell carcinoma patients who received a PN or RN from 2019 to 2021, performed via a robotic-assisted or open approach by one surgeon only for each approach, respectively. The aim of the study was to examine patient and tumor characteristics as well as oncologic outcome.
Results: Most patients were treated with a PN (81%), of these 95% in the robotic-assisted and 70% in open group. Histological subtypes in the whole study population were clear cell in 66% of all cases, papillary in 17%, chromophobe in 11% and others in 6%. 3 patients had sarcomatoid features. Complex tumors were significantly more often treated via an open approach, as these tumors showed a significantly higher T-stage (p<0.001), tumor size (4.4 vs. 2.9 cm; p<0.001), PADUA-score (11 vs 6; p<0.001) and RENAL-score (10,5 vs 6; p<0.001). Patients receiving a robotic-assisted approach had longer duration of surgery (194 vs 137 min; p<0.001), but a lower blood loss (50 vs 200 ml; p<0.001) and a shorter hospital stay (5 vs. 7 days; p<0.001). An open surgical approach was associated with a higher number of post-operative complications (20% vs. 3%, p=0.003), however most complications were Clavien-Dindo Grad 1–2 and could be easily treated without any residuals. Clavien-Dindo ≥ Grad 3 complications were the need of a chest tube drainage due to pneumothorax in the robotic-assisted approach and bleeding with open revision, bleeding treated by embolization (3x), ureteral stent placement (2x), stroke and pulmonary insufficiency with intensive-care treatment in the open approach. There were no differences regarding intra-operative complications (p=0.283) or hospital readmission (p=0.207). Furthermore, relapse-free survival (6% vs. 4%, p=0.635) and overall survival (97% vs. 100%, p=0.214) were not different between the robotic-assisted or open approach.
Conclusion: In our cohort of patients, more complex renal cell carcinoma were treated with an open approach. Although post-operative complication rate was higher in open surgery, even complex tumors can be safely cured using a nephron sparing open approach. Our data demonstrate that the surgeon represents the most important factor for optimal outcome of PN even in complex tumors.
