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J Urol. 2019 Oct 14:101097JU0000000000000591. doi: 10.1097/JU.0000000000000591. [Epub ahead of print]

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

Author information

1
Department of Urology, University of Florence, Florence, Italy.
2
Department of Urology, Spectrum Health Medical Group, Grand Rapids, Michigan.
3
Department of Urology, European Institute of Oncology (IEO), University of Milan, Milan, Italy.
4
Bristol Urological Institute, Southmead Hospital, Bristol, United Kingdom.
5
Uro-oncology Unit, Fundació Puigvert, Barcelona, Spain.
6
Departments of Urology, Technical University of Munich, University Hospital Klinikum Rechts Der Isar, Munich, Germany.
7
Department of Urology and Pediatric Urology, Julius-Maximilians-University of Würzburg, Würzburg, Germany.
8
Departments of Urology, University of Brescia, Brescia, Italy.
9
Departments of Urology, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands.
10
Royal Bournemouth Hospital, Bournemouth, United Kingdom.
11
Medical University of Vienna, Vienna, Austria.
12
ASST Papa Giovanni XXIII, Bergamo, Italy.
13
Departments of Urology, School of Medicine, Hacettepe University, Ankara, Turkey.
14
Dışkapı Yıldırım Beyazıt Training and Research Hospital, Ankara, Turkey.
15
Department of Urology, Graz Medical University, Graz, Austria.
16
Department of Urology and Andrology, Donauspital, Vienna, Austria.
17
Unit of Urology, Division of Experimental Oncology, Urological Research Institute (URI), IRCCS Ospedale San Raffaele, Milan, Italy.
18
University of Eastern Piedmont, Maggiore della Carità Hospital, Novara, Italy.
19
Campus Grosshadern, Ludwig-Maximilians University, Munich, Germany.
20
Janssen Pharma Research and Development, Los Angeles, California.
21
Division of Urologic Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania.

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.

KEYWORDS:

acute kidney injury; intraoperative complications; kidney neoplasms, nephrectomy; margins of excision

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