Impact of Resection Technique on Perioperative Outcomes and Surgical Margins after Partial Nephrectomy for Localized Renal Masses: A Prospective Multicenter Study

No AccessJournal of UrologyAdult Urology1 Mar 2020Impact of Resection Technique on Perioperative Outcomes and Surgical Margins after Partial Nephrectomy for Localized Renal Masses: A Prospective Multicenter StudyThis article is commented on by the following:Editorial Comment Andrea Minervini, Riccardo Campi, Brian R. Lane, Ottavio De Cobelli, Francesco Sanguedolce, Georgios Hatzichristodoulou, Alessandro Antonelli, Sabrina Noyes, Andrea Mari, Oscar Rodriguez-Faba, Frank X. Keeley, Johan Langenhuijsen, Gennaro Musi, Tobias Klatte, Marco Roscigno, Bulent Akdogan, Maria Furlan, Nihat Karakoyunlu, Martin Marszalek, Umberto Capitanio, Alessandro Volpe, Sabine Brookman-May, Jürgen E. Gschwend, Marc C. Smaldone, Robert G. Uzzo, Marco Carini, and Alexander Kutikov Andrea MinerviniAndrea Minervini *Correspondence: Clinica Urologica I, Azienda Ospedaliera Careggi, Università di Firenze, Viale San Luca, 50134, Firenze, Italy telephone: +390552758011, +390557949209 or +393475865716; FAX: +390552758014; E-mail Address: [email protected] Department of Urology, University of Florence, Florence, Italy Equal study contribution. More articles by this author , Riccardo CampiRiccardo Campi Department of Urology, University of Florence, Florence, Italy Equal study contribution. More articles by this author , Brian R. LaneBrian R. Lane Department of Urology, Spectrum Health Medical Group, Grand Rapids, Michigan More articles by this author , Ottavio De CobelliOttavio De Cobelli Department of Urology, European Institute of Oncology (IEO), University of Milan, Milan, Italy More articles by this author , Francesco SanguedolceFrancesco Sanguedolce Bristol Urological Institute, Southmead Hospital, Bristol, United Kingdom Uro-oncology Unit, Fundació Puigvert, Barcelona, Spain More articles by this author , Georgios HatzichristodoulouGeorgios Hatzichristodoulou Department of Urology, Technical University of Munich, University Hospital Klinikum Rechts Der Isar, Munich, Germany Department of Urology and Pediatric Urology, Julius-Maximilians-University of Würzburg, Würzburg, Germany More articles by this author , Alessandro AntonelliAlessandro Antonelli Department of Urology, University of Brescia, Brescia, Italy More articles by this author , Sabrina NoyesSabrina Noyes Department of Urology, Spectrum Health Medical Group, Grand Rapids, Michigan More articles by this author , Andrea MariAndrea Mari Department of Urology, University of Florence, Florence, Italy More articles by this author , Oscar Rodriguez-FabaOscar Rodriguez-Faba Uro-oncology Unit, Fundació Puigvert, Barcelona, Spain More articles by this author , Frank X. KeeleyFrank X. Keeley Bristol Urological Institute, Southmead Hospital, Bristol, United Kingdom More articles by this author , Johan LangenhuijsenJohan Langenhuijsen Department of Urology, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands More articles by this author , Gennaro MusiGennaro Musi Department of Urology, European Institute of Oncology (IEO), University of Milan, Milan, Italy More articles by this author , Tobias KlatteTobias Klatte Royal Bournemouth Hospital, Bournemouth, United Kingdom Medical University of Vienna, Vienna, Austria More articles by this author , Marco RoscignoMarco Roscigno ASST Papa Giovanni XXIII, Bergamo, Italy More articles by this author , Bulent AkdoganBulent Akdogan Department of Urology, School of Medicine, Hacettepe University, Ankara, Turkey More articles by this author , Maria FurlanMaria Furlan Department of Urology, University of Brescia, Brescia, Italy More articles by this author , Nihat KarakoyunluNihat Karakoyunlu Dışkapı Yıldırım Beyazıt Training and Research Hospital, Ankara, Turkey More articles by this author , Martin MarszalekMartin Marszalek Department of Urology, Graz Medical University, Graz Department of Urology and Andrology, Donauspital, Vienna, Austria More articles by this author , Umberto CapitanioUmberto Capitanio Unit of Urology, Division of Experimental Oncology, Urological Research Institute (URI), IRCCS Ospedale San Raffaele, Milan, Italy More articles by this author , Alessandro VolpeAlessandro Volpe University of Eastern Piedmont, Maggiore della Carità Hospital, Novara, Italy More articles by this author , Sabine Brookman-MaySabine Brookman-May Campus Grosshadern, Ludwig-Maximilians University, Munich, Germany Janssen Pharma Research and Development, Los Angeles, California More articles by this author , Jürgen E. GschwendJürgen E. Gschwend Department of Urology, Technical University of Munich, University Hospital Klinikum Rechts Der Isar, Munich, Germany More articles by this author , Marc C. SmaldoneMarc C. Smaldone Division of Urologic Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania More articles by this author , Robert G. UzzoRobert G. Uzzo Division of Urologic Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania More articles by this author , Marco CariniMarco Carini Department of Urology, University of Florence, Florence, Italy More articles by this author , and Alexander KutikovAlexander Kutikov Division of Urologic Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania More articles by this author for the SIB International Consortium View All Author Informationhttps://doi.org/10.1097/JU.0000000000000591AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract 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. References 1. : European Association of Urology Guidelines on renal cell carcinoma: the 2019 update. Eur Urol 2019; 75: 799. Google Scholar 2. : Renal mass and localized renal cancer: AUA guideline. J Urol 2017; 198: 520. Link, Google Scholar 3. : Excisional precision matters: understanding the influence of excisional volume loss on renal function after partial nephrectomy. Eur Urol 2017; 72: 168. Google Scholar 4. : Tumor enucleation for sporadic localized kidney cancer: pro and con. J Urol 2015; 194: 623. 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Google Scholar The corresponding author certifies that, when applicable, a statement(s) has been included in the manuscript documenting institutional review board, ethics committee or ethical review board study approval; principles of Helsinki Declaration were followed in lieu of formal ethics committee approval; institutional animal care and use committee approval; all human subjects provided written informed consent with guarantees of confidentiality; IRB approved protocol number; animal approved project number. No direct or indirect commercial, personal, academic, political, religious or ethical incentive is associated with publishing this article. © 2020 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetailsRelated articlesJournal of UrologyNov 27, 2019, 12:00:00 AMEditorial Comment Volume 203Issue 3March 2020Page: 496-504Supplementary Materials Advertisement Copyright & Permissions© 2020 by American Urological Association Education and Research, Inc.Keywordskidney neoplasms, nephrectomymargins of excisionintraoperative complicationsacute kidney injuryMetricsAuthor Information Andrea Minervini Department of Urology, University of Florence, Florence, Italy *Correspondence: Clinica Urologica I, Azienda Ospedaliera Careggi, Università di Firenze, Viale San Luca, 50134, Firenze, Italy telephone: +390552758011, +390557949209 or +393475865716; FAX: +390552758014; E-mail Address: [email protected] Equal study contribution. More articles by this author Riccardo Campi Department of Urology, University of Florence, Florence, Italy Equal study contribution. More articles by this author Brian R. Lane Department of Urology, Spectrum Health Medical Group, Grand Rapids, Michigan More articles by this author Ottavio De Cobelli Department of Urology, European Institute of Oncology (IEO), University of Milan, Milan, Italy More articles by this author Francesco Sanguedolce Bristol Urological Institute, Southmead Hospital, Bristol, United Kingdom Uro-oncology Unit, Fundació Puigvert, Barcelona, Spain More articles by this author Georgios Hatzichristodoulou Department of Urology, Technical University of Munich, University Hospital Klinikum Rechts Der Isar, Munich, Germany Department of Urology and Pediatric Urology, Julius-Maximilians-University of Würzburg, Würzburg, Germany More articles by this author Alessandro Antonelli Department of Urology, University of Brescia, Brescia, Italy More articles by this author Sabrina Noyes Department of Urology, Spectrum Health Medical Group, Grand Rapids, Michigan More articles by this author Andrea Mari Department of Urology, University of Florence, Florence, Italy More articles by this author Oscar Rodriguez-Faba Uro-oncology Unit, Fundació Puigvert, Barcelona, Spain More articles by this author Frank X. Keeley Bristol Urological Institute, Southmead Hospital, Bristol, United Kingdom More articles by this author Johan Langenhuijsen Department of Urology, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands More articles by this author Gennaro Musi Department of Urology, European Institute of Oncology (IEO), University of Milan, Milan, Italy More articles by this author Tobias Klatte Royal Bournemouth Hospital, Bournemouth, United Kingdom Medical University of Vienna, Vienna, Austria More articles by this author Marco Roscigno ASST Papa Giovanni XXIII, Bergamo, Italy More articles by this author Bulent Akdogan Department of Urology, School of Medicine, Hacettepe University, Ankara, Turkey More articles by this author Maria Furlan Department of Urology, University of Brescia, Brescia, Italy More articles by this author Nihat Karakoyunlu Dışkapı Yıldırım Beyazıt Training and Research Hospital, Ankara, Turkey More articles by this author Martin Marszalek Department of Urology, Graz Medical University, Graz Department of Urology and Andrology, Donauspital, Vienna, Austria More articles by this author Umberto Capitanio Unit of Urology, Division of Experimental Oncology, Urological Research Institute (URI), IRCCS Ospedale San Raffaele, Milan, Italy More articles by this author Alessandro Volpe University of Eastern Piedmont, Maggiore della Carità Hospital, Novara, Italy More articles by this author Sabine Brookman-May Campus Grosshadern, Ludwig-Maximilians University, Munich, Germany Janssen Pharma Research and Development, Los Angeles, California More articles by this author Jürgen E. Gschwend Department of Urology, Technical University of Munich, University Hospital Klinikum Rechts Der Isar, Munich, Germany More articles by this author Marc C. Smaldone Division of Urologic Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania More articles by this author Robert G. Uzzo Division of Urologic Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania More articles by this author Marco Carini Department of Urology, University of Florence, Florence, Italy More articles by this author Alexander Kutikov Division of Urologic Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania More articles by this author Expand All The corresponding author certifies that, when applicable, a statement(s) has been included in the manuscript documenting institutional review board, ethics committee or ethical review board study approval; principles of Helsinki Declaration were followed in lieu of formal ethics committee approval; institutional animal care and use committee approval; all human subjects provided written informed consent with guarantees of confidentiality; IRB approved protocol number; animal approved project number. 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