Journal Article

Contemporary Outcomes of Robot-Assisted Partial Nephrectomy: Results from Two European Referral Institutions

Smits, Geert, De Naeyer, Geert, Resca, Stefano, Schatteman, Peter, De Groote, Ruben, Ticonosco, Marco, Mottrie, Alexandre, Kroon, Bin K., Mourullo, Andrea Noya, D’Hondt, Frederick, Pissavini, Alessandro, Barletta, Francesco, de Angelis, Mario, Papenburg, Bernke, Lambert, Edward, Vecchio, Enrico, Tamburini, Sara, Frego, Nicola

2025

Overview

Introduction: Available guidelines recommend performing nephron-sparing surgery in selected renal cell carcinoma (RCC) patients. Many studies provided robot-assisted partial nephrectomy (RAPN) functional and oncological outcomes, with most of these including a wide timespan and a number of surgeons with different experiences, which might lead to the heterogeneity of the results. In this study, we aim to provide a contemporary report of RAPN patient outcomes performed at two referral centers by experienced surgeons. Materials and Methods: Overall, 333 RAPN patients treated at two European referral centers between 2019 and 2021 were identified. Continuous and categorical variables were reported using medians and proportions. Multi-variable logistic regression (MLR) models were fitted to test predictors of off-clamp technique use and trifecta achievement. Results: The median age was 65 (IQR: 57–73) years. The clinical stage distribution was as follows: 224 (67%) cT1a vs. 89 (26%) cT1b vs. 20 cT2 (7%). The median warm ischemia time was 14 (10–18) minutes, with trifecta being achieved in 74% (n = 240) of patients. In MLR models predicting off-clamp surgery, an increasing R.E.N.A.L. score was independently associated with a lower chance of attempting such a technique (OR: 0.69, p-value < 0.001). In models predicting trifecta achievement, both a higher R.E.N.A.L. score (OR: 0.78, p-value = 0.007) and the presence of multiple lesions (OR: 0.29, p-value = 0.007) were independently associated with lower chances of reaching the outcome. Significant upstaging of chronic kidney disease (CKD) stage was recorded in 9.4% of patients after one year of follow-up. Conclusions: We reported the contemporary outcomes of patients treated with RAPN by highly experienced surgeons from two referral centers. This report represents a valid benchmark that could be used for individual patient counseling in the decision-making process.

• Publisher: MDPI AG,MDPI
• Subject: Age / Body mass index / Care and treatment / Chronic kidney failure / Decision making / Ischemia / Kidney cancer / Kidney diseases / Laparoscopy / Learning curves / Medical referrals / Mortality / Nephrectomy / Patient outcomes / Patients / Regression analysis / Renal cell carcinoma / Robotic surgery / Robotics / Surgeons / Surgery / Variables