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Abstract

Objective:

To identify factors associated with preserved split renal function (SRF) after robot-assisted partial nephrectomy (RAPN).

Patients and Methods:

The study included patients who underwent RAPN at Nagasaki University Hospital between November 2016 and December 2023. SRF was determined by 99mTc-dimercaptosuccinic acid renal imaging and the estimated glomerular filtration rate, with measurements obtained before and 6 months after surgery. The ipsilateral parenchymal volume (IPV) was measured at the same time. More than 90% SRF after surgery was considered to indicate successful preservation of renal function (the successful group), and ≤90% SRF was considered failure to preserve renal function (the unsuccessful group). The factors most relevant to SRF were sought in univariate and multivariate analyses.

Results:

Data for a total of 169 patients were analyzed. The median SRF was 32.04 mL/min/1.73 m² (interquartile range [IQR] 25.95, 38.06) before surgery and 27.33 mL/min/1.73 m² (IQR 21.64, 34.32) after surgery. The median SRF preservation rate was 88% (IQR 78.4, 97.0), with 94 cases (55.6%) having SRF >90% and 75 cases (44%) having SRF ≤90%. The median IPV on the surgical side was calculated by the software to be 152.2 cm³ (IQR 126.9, 186.6) preoperatively and 127.3 cm³ (IQR 102.9, 161.3) postoperatively, with a median preservation rate of 84.6% (IQR 72.2, 89.7). Univariate analysis showed significant between-group differences in diabetes status, RENAL Nephrometry score, operation time, warm ischemia time, whether or not parenchymal sutures were needed, and the amount of IPV preserved. Only percentage of IPV preserved remained significant in multivariate analysis.

Conclusion:

The findings of this study suggest that the residual IPV is an important determinant of SRF after RAPN.

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References

Hung

, Cai

, Simmons

, et al. “Trifecta” in partial nephrectomy. J Urol, 2013; 189(1):36–42; doi: 10.1016/j.juro.2012.09.042

Ljungberg

, Albiges

, Abu-Ghanem

, et al. European Association of Urology Guidelines on Renal Cell Carcinoma: The 2022 update. Eur Urol, 2022; 82(4):399–410; doi: 10.1016/j.eururo.2022.03.006

Campbell

, Clark

, Chang

, et al. Renal mass and localized renal cancer: Evaluation, management, and follow-up: AUA guideline: Part I. J Urol, 2021; 206(2):199–208; doi: 10.1097/JU.0000000000001911

Campbell

, Campbell

, Munoz-Lopez

, et al. Every decade counts: A narrative review of functional recovery after partial nephrectomy. BJU Int, 2023; 131(2):165–172; doi: 10.1111/bju.15848

MacLennan

, Imamura

, Lapitan

, et al.; EAU Renal Cancer Guideline Panel. Systematic review of oncological outcomes following surgical management of localised renal cancer. Eur Urol, 2012; 61(5):972–993; doi: 10.1016/j.eururo.2012.02.039

Shekarriz

, Upadhyay

, Shekarriz

, et al. Comparison of costs and complications of radical and partial nephrectomy for treatment of localized renal cell carcinoma. Urology, 2002; 59(2):211–215; doi: 10.1016/s0090-4295(01)01514-x

McKiernan

, Simmons

, Katz

, et al. Natural history of chronic renal insufficiency after partial and radical nephrectomy. Urology, 2002; 59(6):816–820; doi: 10.1016/s0090-4295(02)01501-7

Ohba

, Matsuo

, Mitsunari

, et al. Preservation of split renal function after laparoscopic and robot-assisted partial nephrectomy. Anticancer Res, 2022; 42(6):3055–3060; doi: 10.21873/anticanres.15792

Kobayashi

, Mutaguchi

, Kashiwagi

, et al. Clinical advantages of robot-assisted partial nephrectomy versus laparoscopic partial nephrectomy in terms of global and split renal functions: A propensity score-matched comparative analysis. Int J Urol, 2021; 28(6):630–636; doi: 10.1111/iju.14525

10.

Pierorazio

, Patel

, Feng

, et al. Robotic-assisted versus traditional laparoscopic partial nephrectomy: Comparison of outcomes and evaluation of learning curve. Urology, 2011; 78(4):813–819; doi: 10.1016/j.urology.2011.04.065

11.

Choi

, You

, Kim

, et al. Comparison of perioperative outcomes between robotic and laparoscopic partial nephrectomy: A systematic review and meta-analysis. Eur Urol, 2015; 67(5):891–901; doi: 10.1016/j.eururo.2014.12.028

12.

Ginzburg

, Uzzo

, Walton

, et al. Residual parenchymal volume, not warm ischemia time, predicts ultimate renal functional outcomes in patients undergoing partial nephrectomy. Urology, 2015; 86(2):300–305; doi: 10.1016/j.urology.2015.04.043

13.

Munoz-Lopez

, Lewis

, Attawettayanon

, et al. Functional recovery after partial nephrectomy: Next generation analysis. BJU Int, 2023; 132(2):202–209; doi: 10.1111/bju.16023

14.

Kazama

, Attawettayanon

, Munoz-Lopez

, et al. Parenchymal volume preservation during partial nephrectomy: Improved methodology to assess impact and predictive factors. BJU Int, 2024; 134(2):219–228; doi: 10.1111/bju.16300

15.

Kutikov

, Uzzo

. The R.E.N.A.L. nephrometry score: A comprehensive standardized system for quantitating renal tumor size, location and depth. J Urol, 2009; 182(3):844–853; doi: 10.1016/j.juro.2009.05.035

16.

Levey

, Bosch

, Lewis

, et al. A more accurate method to estimate glomerular filtration rate from serum creatinine: A new prediction equation. Modification of diet in renal disease study group. Ann Intern Med, 1999; 130(6):461–470; doi: 10.7326/0003-4819-130-6-199903160-00002

17.

Kanda

. Investigation of the freely-available easy-to-use software “EZR” (Easy R) for medical statistics. Bone Marrow Transplant, 2013; 48(3):452–458; doi: 10.1038/bmt.2012.244

18.

Uemura

, Kato

, Nagahara

, et al. Therapeutic and clinical outcomes of robot-assisted partial nephrectomy versus cryoablation for T1 renal cell carcinoma. In Vivo, 2021; 35(3):1573–1579; doi: 10.21873/invivo.12413

19.

Satkunasivam

, Tsai

, Syan

, et al. Robotic unclamped “minimal-margin” partial nephrectomy: Ongoing refinement of the anatomic zero-ischemia concept. Eur Urol, 2015; 68(4):705–712; doi: 10.1016/j.eururo.2015.04.044

20.

Puppo

, Introini

, Calvi

, Naselli

. Long term results of excision of small renal cancer surrounded by a minimal layer of grossly normal parenchyma: Review of 94 cases. Eur Urol, 2004; 46(4):477–481; doi: 10.1016/j.eururo.2004.07.007

21.

Piper

, Bishoff

, Magee

, et al. Is a 1-CM margin necessary during nephron-sparing surgery for renal cell carcinoma? Urology, 2001; 58(6):849–852; doi: 10.1016/s0090-4295(01)01393-0

22.

Minervini

, Ficarra

, Rocco

, et al.; SATURN Project-LUNA Foundation. Simple enucleation is equivalent to traditional partial nephrectomy for renal cell carcinoma: Results of a nonrandomized, retrospective, comparative study. J Urol, 2011; 185(5):1604–1610; doi: 10.1016/j.juro.2010.12.048

23.

, Zhao

, Zhang

, et al. Robot-assisted simple enucleation versus standard robot-assisted partial nephrectomy for low- or intermediate-complexity, clinical T1 renal tumors: A randomized controlled noninferiority trial. Eur Urol Oncol, 2024; 7(2):275–281; doi: 10.1016/j.euo.2023.07.019

24.

Plattner

, Sundaram

, Cheng

, Bahler

. Renal volume loss during partial nephrectomy due to resected healthy parenchyma: A tool for quick estimation. J Endourol, 2020; 34(8):856–861; doi: 10.1089/end.2020.0314

25.

Teishima

, Takayama

, Iwaguro

, et al. Usefulness of personalized three-dimensional printed model on the satisfaction of preoperative education for patients undergoing robot-assisted partial nephrectomy and their families. Int Urol Nephrol, 2018; 50(6):1061–1066; doi: 10.1007/s11255-018-1881-2

26.

Ghazi

, Melnyk

, Hung

, et al. Multi-institutional validation of a perfused robot-assisted partial nephrectomy procedural simulation platform utilizing clinically relevant objective metrics of simulators (CROMS). BJU Int, 2021; 127(6):645–653; doi: 10.1111/bju.15246

27.

Piana

, Amparore

, Sica

, et al. Automatic 3D augmented-reality robot-assisted partial nephrectomy using machine learning: Our pioneer experience. Cancers (Basel), 2024; 16(5):1047; doi: 10.3390/cancers16051047