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Impact of Resection Technique on Perioperative Outcomes and Surgical Margins after Partial Nephrectomy for Localized Renal Masses: A Prospective Multicenter Study.
Minervini, Andrea; Campi, Riccardo; Lane, Brian R; De Cobelli, Ottavio; Sanguedolce, Francesco; Hatzichristodoulou, Georgios; Antonelli, Alessandro; Noyes, Sabrina; Mari, Andrea; Rodriguez-Faba, Oscar; Keeley, Frank X; Langenhuijsen, Johan; Musi, Gennaro; Klatte, Tobias; Roscigno, Marco; Akdogan, Bulent; Furlan, Maria; Karakoyunlu, Nihat; Marszalek, Martin; Capitanio, Umberto; Volpe, Alessandro; Brookman-May, Sabine; Gschwend, Jürgen E; Smaldone, Marc C; Uzzo, Robert G; Carini, Marco; Kutikov, Alexander.
Afiliación
  • Minervini A; Department of Urology, University of Florence, Florence, Italy.
  • Campi R; Department of Urology, University of Florence, Florence, Italy.
  • Lane BR; Department of Urology, Spectrum Health Medical Group, Grand Rapids, Michigan.
  • De Cobelli O; Department of Urology, European Institute of Oncology (IEO), University of Milan, Milan, Italy.
  • Sanguedolce F; Bristol Urological Institute, Southmead Hospital, Bristol, United Kingdom.
  • Hatzichristodoulou G; Uro-oncology Unit, Fundació Puigvert, Barcelona, Spain.
  • Antonelli A; Department of Urology, Technical University of Munich, University Hospital Klinikum Rechts Der Isar, Munich, Germany.
  • Noyes S; Department of Urology and Pediatric Urology, Julius-Maximilians-University of Würzburg, Würzburg, Germany.
  • Mari A; Department of Urology, University of Brescia, Brescia, Italy.
  • Rodriguez-Faba O; Department of Urology, Spectrum Health Medical Group, Grand Rapids, Michigan.
  • Keeley FX; Department of Urology, University of Florence, Florence, Italy.
  • Langenhuijsen J; Uro-oncology Unit, Fundació Puigvert, Barcelona, Spain.
  • Musi G; Bristol Urological Institute, Southmead Hospital, Bristol, United Kingdom.
  • Klatte T; Department of Urology, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands.
  • Roscigno M; Department of Urology, European Institute of Oncology (IEO), University of Milan, Milan, Italy.
  • Akdogan B; Royal Bournemouth Hospital, Bournemouth, United Kingdom.
  • Furlan M; Medical University of Vienna, Vienna, Austria.
  • Karakoyunlu N; ASST Papa Giovanni XXIII, Bergamo, Italy.
  • Marszalek M; Department of Urology, School of Medicine, Hacettepe University, Ankara, Turkey.
  • Capitanio U; Department of Urology, University of Brescia, Brescia, Italy.
  • Volpe A; Diskapi Yildirim Beyazit Training and Research Hospital, Ankara, Turkey.
  • Brookman-May S; Department of Urology, Graz Medical University, Graz.
  • Gschwend JE; Department of Urology and Andrology, Donauspital, Vienna, Austria.
  • Smaldone MC; Unit of Urology, Division of Experimental Oncology, Urological Research Institute (URI), IRCCS Ospedale San Raffaele, Milan, Italy.
  • Uzzo RG; University of Eastern Piedmont, Maggiore della Carità Hospital, Novara, Italy.
  • Carini M; Campus Grosshadern, Ludwig-Maximilians University, Munich, Germany.
  • Kutikov A; Janssen Pharma Research and Development, Los Angeles, California.
J Urol ; 203(3): 496-504, 2020 03.
Article en En | MEDLINE | ID: mdl-31609167
PURPOSE: The impact of resection technique on partial nephrectomy outcomes is controversial. The aim of this study was to evaluate the pattern of resection techniques during partial nephrectomy and the impact on perioperative outcomes, acute kidney injury, positive surgical margins and the achievement of the Trifecta (negative surgical margins, no perioperative Clavien-Dindo grade 2 or greater surgical complications and no postoperative acute kidney injury). MATERIALS AND METHODS: We prospectively collected data on consecutive patients with cT1-2N0M0 renal masses treated with partial nephrectomy at a total of 16 referral centers from September 2014 to March 2015. After partial nephrectomy the resection technique was classified by the surgeon as enucleation, enucleoresection or resection according to the SIB (Surface-Intermediate-Base) margin scores 0 to 2, 3 or 4 and 5, respectively. Multivariable logistic regression analysis was done to evaluate the potential impact of the resection technique on postoperative surgical complications, positive surgical margins, acute kidney injury and Trifecta achievement. RESULTS: Overall 507 patients were included in analysis. The resection technique was classified as enucleation in 266 patients (52%), enucleoresection in 150 (30%) and resection in 91 (18%). The resection technique (enucleoresection vs enucleation and resection) was the only significant predictor of positive surgical margins. Tumor complexity, surgical approach (open and laparoscopic vs robotic) and resection technique (enucleoresection vs enucleation) were significant predictors of Clavien-Dindo grade 2 or greater surgical complications. The surgical approach (open and laparoscopic vs robotic), the resection technique (enucleoresection vs enucleation) and warm ischemia time were significantly associated with postoperative acute kidney injury and Trifecta achievement. CONCLUSIONS: Resection techniques significantly impact surgical complications, early functional outcomes and positive surgical margins after partial nephrectomy of localized renal masses.
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Complicaciones Posoperatorias / Márgenes de Escisión / Neoplasias Renales / Nefrectomía Tipo de estudio: Clinical_trials / Observational_studies / Prognostic_studies / Risk_factors_studies Límite: Aged / Female / Humans / Male / Middle aged Idioma: En Revista: J Urol Año: 2020 Tipo del documento: Article País de afiliación: Italia Pais de publicación: Estados Unidos

Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Complicaciones Posoperatorias / Márgenes de Escisión / Neoplasias Renales / Nefrectomía Tipo de estudio: Clinical_trials / Observational_studies / Prognostic_studies / Risk_factors_studies Límite: Aged / Female / Humans / Male / Middle aged Idioma: En Revista: J Urol Año: 2020 Tipo del documento: Article País de afiliación: Italia Pais de publicación: Estados Unidos