Mp44-08 Patients With Imperative Robot-Assisted Partial Nephrectomy Have Worse Outcomes Than Those With Elective Indications

You have accessJournal of UrologyKidney Cancer: Localized: Surgical Therapy III (MP44)1 May 2024MP44-08 PATIENTS WITH IMPERATIVE ROBOT-ASSISTED PARTIAL NEPHRECTOMY HAVE WORSE OUTCOMES THAN THOSE WITH ELECTIVE INDICATIONS Yuzhi Wang, Kennedy E. Okhawere, Indu Saini, Laura Zuluaga, Nicolas A. Soputro, Michael Raver, Onika Dv Noel, Mutahar Ahmed, Reza Mehrazin, Ronney Abaza, Daniel D. Eun, Akshay Bhandari, Ashok K. Hemal, James Porter, Michael Stifelman, Jihad Kaouk, Ruben Sauer Calvo, Simone Crivellaro, Nirmish Singla, Ahmed M. Mansour, Ketan K. Badani, and Craig G. Rogers Yuzhi WangYuzhi Wang , Kennedy E. OkhawereKennedy E. Okhawere , Indu SainiIndu Saini , Laura ZuluagaLaura Zuluaga , Nicolas A. SoputroNicolas A. Soputro , Michael RaverMichael Raver , Onika Dv NoelOnika Dv Noel , Mutahar AhmedMutahar Ahmed , Reza MehrazinReza Mehrazin , Ronney AbazaRonney Abaza , Daniel D. EunDaniel D. Eun , Akshay BhandariAkshay Bhandari , Ashok K. HemalAshok K. Hemal , James PorterJames Porter , Michael StifelmanMichael Stifelman , Jihad KaoukJihad Kaouk , Ruben Sauer CalvoRuben Sauer Calvo , Simone CrivellaroSimone Crivellaro , Nirmish SinglaNirmish Singla , Ahmed M. MansourAhmed M. Mansour , Ketan K. BadaniKetan K. Badani , and Craig G. RogersCraig G. Rogers View All Author Informationhttps://doi.org/10.1097/01.JU.0001009508.69111.d0.08AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Robot-assisted partial nephrectomy (RAPN) is increasingly utilized for patients with larger and more complex tumors, which may include those with imperative indications for PN. We compared peri-operative outcomes after RAPN between patients with imperative and elective indications for PN. METHODS: Using a multi-institutional kidney database, retrospective review was performed on patients who underwent RAPN. Patients were stratified into the imperative or elective cohort. Imperative indications include patients with a solitary kidney, moderate (GFR<60) to severe (GFR<30) CKD, bilateral renal tumors, or history of hereditary renal cancer. The cohorts were matched using 1:1 propensity score matching. Patient, tumor, and peri-operative data were compared between the cohorts. RESULTS: Out of 1,656 patients that underwent RAPN, 548 (33%) patients had imperative PN. Prior to propensity score matching, the imperative group was older on average (67 vs. 59 years) and had higher Charlson comorbidity index (4 vs. 3). After 1:1 propensity score matching, 548 patients were in each cohort, and patient characteristics were balanced between the two groups. Patients with imperative PN had a significantly longer ischemia time (14 vs. 12 minutes, p<0.001), higher rate of any post-operative complication (16% vs. 6.2%, p<0.001) and major complication with Clavien-Dindo grade≥3 (5.1% vs. 1.3%, p<0.001). Otherwise, no differences in terms of operative time, blood loss, conversion to open or radical nephrectomy, intra-operative complications, or positive surgical margins were observed (Table 1). There was no difference in post-operative change in GFR. CONCLUSIONS: Patients with imperative indications for RAPN had a higher rate of postoperative complications. Despite having a longer ischemia time, the imperative group still had a comparable decline in renal function. While imperative RAPN may require greater technical demands, it more importantly provides reasonable outcomes for patients that need PN the most. Source of Funding: None © 2024 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 211Issue 5SMay 2024Page: e733 Advertisement Copyright & Permissions© 2024 by American Urological Association Education and Research, Inc.Metrics Author Information Yuzhi Wang More articles by this author Kennedy E. Okhawere More articles by this author Indu Saini More articles by this author Laura Zuluaga More articles by this author Nicolas A. Soputro More articles by this author Michael Raver More articles by this author Onika Dv Noel More articles by this author Mutahar Ahmed More articles by this author Reza Mehrazin More articles by this author Ronney Abaza More articles by this author Daniel D. Eun More articles by this author Akshay Bhandari More articles by this author Ashok K. Hemal More articles by this author James Porter More articles by this author Michael Stifelman More articles by this author Jihad Kaouk More articles by this author Ruben Sauer Calvo More articles by this author Simone Crivellaro More articles by this author Nirmish Singla More articles by this author Ahmed M. Mansour More articles by this author Ketan K. Badani More articles by this author Craig G. Rogers More articles by this author Expand All Advertisement PDF downloadLoading ...