Reoperative Partial Nephrectomy—Does Previous Surgical Footprint Impact Outcomes?

No AccessJournal of UrologyAdult Urology1 Sep 2021Reoperative Partial Nephrectomy—Does Previous Surgical Footprint Impact Outcomes?This article is commented on by the following:Editorial Comment Sandeep Gurram, Nicholas A. Friedberg, Chirag Gordhan, Winston Li, Michael A. Ahdoot, Jillian Egan, Nitin K. Yerram, Gennady Bratslavsky, Adam R. Metwalli, W. Marston Linehan, and Mark W. Ball Sandeep GurramSandeep Gurram http://orcid.org/0000-0002-6405-9269 Urologic Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland More articles by this author , Nicholas A. FriedbergNicholas A. Friedberg Urologic Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland Department of Urology, George Washington University Medical School, Washington, District of Columbia More articles by this author , Chirag GordhanChirag Gordhan Urologic Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland Department of Urology, George Washington University Medical School, Washington, District of Columbia More articles by this author , Winston LiWinston Li Urologic Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland More articles by this author , Michael A. AhdootMichael A. Ahdoot Urologic Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland More articles by this author , Jillian EganJillian Egan Urologic Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland Department of Urology, MedStar Georgetown University Hospital, Washington, District of Columbia More articles by this author , Nitin K. YerramNitin K. Yerram Urologic Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland More articles by this author , Gennady BratslavskyGennady Bratslavsky Urologic Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland Department of Urology, SUNY Upstate Medical Center, Syracuse, New York More articles by this author , Adam R. MetwalliAdam R. Metwalli Urologic Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland Division of Urology, Department of Surgery, Howard University College of Medicine, Washington, District of Columbia More articles by this author , W. Marston LinehanW. Marston Linehan Urologic Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland More articles by this author , and Mark W. BallMark W. Ball *Correspondence: Center for Cancer Research, National Cancer Institute, Building 10, Room 1-5940, Bethesda, Maryland 20892-1107 telephone: 240-858-3700; FAX: 301-480-2869; E-mail Address: [email protected] Urologic Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000001837AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract Purpose: Historically, open techniques have been favored over minimally invasive approaches for complex surgeries. We aimed to identify differences in perioperative outcomes, surgical footprints, and complication rates in patients undergoing either open or robotic reoperative partial nephrectomy. Materials and Methods: A retrospective review of patients undergoing reoperative partial nephrectomy was performed. Patients were assigned to cohorts based on current and prior surgical approaches: open after open, open after minimally invasive surgery, robotic after open, and robotic after minimally invasive surgery cohorts. Perioperative outcomes were compared among cohorts. Factors contributing to complications were assessed. Results: A total of 192 patients underwent reoperative partial nephrectomy, including 103 in the open after open, 10 in the open after minimally invasive surgery, 47 in the robotic after open, and 32 in the robotic after minimally invasive surgery cohorts. The overall and major complication (grade ≥3) rates were 65% and 19%, respectively. The number of blood transfusions, overall complications, and major complications were significantly lower in robotic compared to open surgical cohorts. On multivariate analysis, the robotic approach was protective against major complications (OR 0.3, p=0.02) and estimated blood loss was predictive (OR 1.03, p=0.004). Prior surgical approach was not predictive for major complications. Conclusions: Reoperative partial nephrectomy is feasible using both open and robotic approaches. While the robotic approach was independently associated with fewer major complications, prior approach was not, implying that prior surgical approaches are less important to perioperative outcomes and in contributing to the overall surgical footprint. References 1. : Renal mass and localized renal cancer: AUA guideline. J Urol 2017; 198: 520. Link, Google Scholar 2. : Comparison of 1,800 laparoscopic and open partial nephrectomies for single renal tumors. J Urol 2007; 178: 41. Link, Google Scholar 3. : Feasibility and outcomes of repeat partial nephrectomy. J Urol 2008; 180: 89. Link, Google Scholar 4. : Repeat partial nephrectomy on the solitary kidney: surgical, functional and oncological outcomes. J Urol 2010; 183: 1719. 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Editor's Note: This article is the first of 5 published in this issue for which category 1 CME credits can be earned. Instructions for obtaining credits are given with the questions on pages 791 and 792. © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetailsCited BySmith J (2021) This Month in Adult UrologyJournal of Urology, VOL. 206, NO. 3, (495-497), Online publication date: 1-Sep-2021.Related articlesJournal of UrologyMay 26, 2021, 12:00:00 AMEditorial Comment Volume 206Issue 3September 2021Page: 539-547Supplementary Materials Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.Keywordscarcinoma, renal cellminimally invasive surgical proceduresvon Hippel-Lindau diseaseroboticsMetricsAuthor Information Sandeep Gurram Urologic Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland More articles by this author Nicholas A. Friedberg Urologic Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland Department of Urology, George Washington University Medical School, Washington, District of Columbia More articles by this author Chirag Gordhan Urologic Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland Department of Urology, George Washington University Medical School, Washington, District of Columbia More articles by this author Winston Li Urologic Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland More articles by this author Michael A. Ahdoot Urologic Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland More articles by this author Jillian Egan Urologic Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland Department of Urology, MedStar Georgetown University Hospital, Washington, District of Columbia More articles by this author Nitin K. Yerram Urologic Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland More articles by this author Gennady Bratslavsky Urologic Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland Department of Urology, SUNY Upstate Medical Center, Syracuse, New York More articles by this author Adam R. Metwalli Urologic Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland Division of Urology, Department of Surgery, Howard University College of Medicine, Washington, District of Columbia More articles by this author W. Marston Linehan Urologic Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland More articles by this author Mark W. Ball Urologic Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland *Correspondence: Center for Cancer Research, National Cancer Institute, Building 10, Room 1-5940, Bethesda, Maryland 20892-1107 telephone: 240-858-3700; FAX: 301-480-2869; E-mail Address: [email protected] More articles by this author Expand All This research was supported by the Intramural Research Program of the National Cancer Institute, National Institutes of Health. Editor's Note: This article is the first of 5 published in this issue for which category 1 CME credits can be earned. Instructions for obtaining credits are given with the questions on pages 791 and 792. Advertisement PDF DownloadLoading ...