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Published in: International Journal of Clinical Oncology 1/2019

01-01-2019 | Original Article

Does tumour effraction during robotic partial nephrectomy have any impact on recurrence?

Authors: Zine-Eddine Khene, Benoit Peyronnet, Benjamin Pradère, Corentin Robert, Anna Goujon, Solène-Florence Kammerer-Jacquet, Grégory Verhoest, Nathalie Rioux-Leclercq, Romain Mathieu, Karim Bensalah

Published in: International Journal of Clinical Oncology | Issue 1/2019

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Abstract

Objective

To evaluate the impact of accidental surgical incision into the tumour (ASIT) on oncological outcomes in patients undergoing RPN for a malignant tumour.

Materials and methods

A retrospective review of our prospectively maintained database was performed to identify all patients who underwent RPN for a localized RCC between June 2010 and July 2016. We stratified our cohort into two groups according to the presence of an ASIT. Perioperative data were compared between the two groups. Logistic regression analyses were used to assess the variables associated with ASIT. Recurrence-free survival was estimated using the Kaplan–Meier method and compared between groups with the log-rank test.

Results

A total of 234 patients were identified. 32 (14%) ASIT were observed. Patients’ characteristics were similar in the two groups. Most of intraoperative outcomes were comparable between the two groups, but patients in the ASIT group had greater EBL (475 vs. 300 mL; p = 0.01). In multivariate analysis, tumour size (p = 0.02), RENAL score (p = 0.02), EBL (p = 0.05) and low surgeon experience (p = 0.03) were all predictive factors of ASIT. 15 (6%) of recurrences were observed over a median follow-up of 36 months. There was no difference in recurrence-free survival between the two groups (p = 0.57).

Conclusions

In our experience, accidental surgical incision into the tumour during RPN was a common event that did not appear to compromise oncological outcome.
Literature
1.
go back to reference Campbell S, Uzzo RG, Allaf ME et al (2017) Renal mass and localized renal cancer: AUA guideline. J Urol [Internet] 198:520–529 Campbell S, Uzzo RG, Allaf ME et al (2017) Renal mass and localized renal cancer: AUA guideline. J Urol [Internet] 198:520–529
3.
go back to reference Schiavina R, Mari A, Antonelli A et al (2015) A snapshot of nephron-sparing surgery in Italy: a prospective, multicenter report on clinical and perioperative outcomes (the RECORd 1 project). Eur J Surg Oncol 41(3):346–352CrossRefPubMed Schiavina R, Mari A, Antonelli A et al (2015) A snapshot of nephron-sparing surgery in Italy: a prospective, multicenter report on clinical and perioperative outcomes (the RECORd 1 project). Eur J Surg Oncol 41(3):346–352CrossRefPubMed
4.
go back to reference Peyronnet B, Seisen T, Oger E, Vaessen C et al (2016) Comparison of 1800 robotic and open partial nephrectomies for renal tumors. Ann Surg Oncol 23(13):4277–4283CrossRefPubMed Peyronnet B, Seisen T, Oger E, Vaessen C et al (2016) Comparison of 1800 robotic and open partial nephrectomies for renal tumors. Ann Surg Oncol 23(13):4277–4283CrossRefPubMed
5.
go back to reference Ficarra V, Minervini A, Antonelli A et al (2014) A multicentre matched-pair analysis comparing robot-assisted versus open partial nephrectomy: perioperative results of RAPN vs OPN. BJU Int 113(6):936–941CrossRefPubMed Ficarra V, Minervini A, Antonelli A et al (2014) A multicentre matched-pair analysis comparing robot-assisted versus open partial nephrectomy: perioperative results of RAPN vs OPN. BJU Int 113(6):936–941CrossRefPubMed
6.
go back to reference Novara G, La Falce S, Kungulli A et al (2016) Robot-assisted partial nephrectomy. Int J Surg 36:554–559CrossRefPubMed Novara G, La Falce S, Kungulli A et al (2016) Robot-assisted partial nephrectomy. Int J Surg 36:554–559CrossRefPubMed
7.
go back to reference Ficarra V, Righetti R, Pilloni S et al (2002) Prognostic factors in patients with renal cell carcinoma: retrospective analysis of 675 cases. Eur Urol 41(2):190–198CrossRefPubMed Ficarra V, Righetti R, Pilloni S et al (2002) Prognostic factors in patients with renal cell carcinoma: retrospective analysis of 675 cases. Eur Urol 41(2):190–198CrossRefPubMed
8.
go back to reference Tanaka T, Terai Y, Maeda K et al (2017) Intraperitoneal cytology after laparoscopic hysterectomy in patients with endometrial cancer: a retrospective observational study. Medicine 96(27):e7502CrossRefPubMedPubMedCentral Tanaka T, Terai Y, Maeda K et al (2017) Intraperitoneal cytology after laparoscopic hysterectomy in patients with endometrial cancer: a retrospective observational study. Medicine 96(27):e7502CrossRefPubMedPubMedCentral
9.
go back to reference Paolucci V, Schaeff B, Schneider M et al (1999) Tumor seeding following laparoscopy: international survey. World J Surg 23(10):989–995CrossRefPubMed Paolucci V, Schaeff B, Schneider M et al (1999) Tumor seeding following laparoscopy: international survey. World J Surg 23(10):989–995CrossRefPubMed
10.
go back to reference Benway BM, Wang AJ, Cabello JM et al (2009) Robotic partial nephrectomy with sliding-clip renorrhaphy: technique and outcomes. Eur Urol 55(3):592–599CrossRefPubMed Benway BM, Wang AJ, Cabello JM et al (2009) Robotic partial nephrectomy with sliding-clip renorrhaphy: technique and outcomes. Eur Urol 55(3):592–599CrossRefPubMed
11.
go back to reference Kutikov A, Uzzo RG (2009) The R.E.N.A.L. nephrometry score: a comprehensive standardized system for quantitating renal tumor size, location and depth. J Urol 182(3):844–853CrossRefPubMed Kutikov A, Uzzo RG (2009) The R.E.N.A.L. nephrometry score: a comprehensive standardized system for quantitating renal tumor size, location and depth. J Urol 182(3):844–853CrossRefPubMed
12.
go back to reference Davidiuk AJ, Parker AS, Thomas CS et al (2014) Mayo adhesive probability score: an accurate image-based scoring system to predict adherent perinephric fat in partial nephrectomy. Eur Urol 66(6):1165–1171CrossRefPubMed Davidiuk AJ, Parker AS, Thomas CS et al (2014) Mayo adhesive probability score: an accurate image-based scoring system to predict adherent perinephric fat in partial nephrectomy. Eur Urol 66(6):1165–1171CrossRefPubMed
13.
go back to reference Dindo D, Demartines N, Clavien P-A (2004) Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 240(2):205–213CrossRefPubMedPubMedCentral Dindo D, Demartines N, Clavien P-A (2004) Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 240(2):205–213CrossRefPubMedPubMedCentral
14.
go back to reference Shah PH, Moreira DM, Okhunov Z et al (2016) Positive surgical margins increase risk of recurrence after partial nephrectomy for high risk renal tumors. J Urol 196(2):327–334CrossRefPubMed Shah PH, Moreira DM, Okhunov Z et al (2016) Positive surgical margins increase risk of recurrence after partial nephrectomy for high risk renal tumors. J Urol 196(2):327–334CrossRefPubMed
15.
go back to reference Autorino R, Porpiglia F, Dasgupta P et al (2017) Precision surgery and genitourinary cancers. Eur J Surg Oncol 43(5):893–908CrossRefPubMed Autorino R, Porpiglia F, Dasgupta P et al (2017) Precision surgery and genitourinary cancers. Eur J Surg Oncol 43(5):893–908CrossRefPubMed
16.
go back to reference Sutherland SE, Resnick MI, Maclennan GT et al (2002) Does the size of the surgical margin in partial nephrectomy for renal cell cancer really matter? J Urol 167(1):61–64CrossRefPubMed Sutherland SE, Resnick MI, Maclennan GT et al (2002) Does the size of the surgical margin in partial nephrectomy for renal cell cancer really matter? J Urol 167(1):61–64CrossRefPubMed
17.
go back to reference Parker WP, Cheville JC, Frank I et al (2017) Application of the stage, size, grade, and necrosis (SSIGN) score for clear cell renal cell carcinoma in contemporary patients. Eur Urol 71(4):665–673CrossRefPubMed Parker WP, Cheville JC, Frank I et al (2017) Application of the stage, size, grade, and necrosis (SSIGN) score for clear cell renal cell carcinoma in contemporary patients. Eur Urol 71(4):665–673CrossRefPubMed
18.
go back to reference Bretheau D, Lechevallier E, de Fromont M et al (1995) Prognostic value of nuclear grade of renal cell carcinoma. Cancer 76(12):2543–2549CrossRefPubMed Bretheau D, Lechevallier E, de Fromont M et al (1995) Prognostic value of nuclear grade of renal cell carcinoma. Cancer 76(12):2543–2549CrossRefPubMed
19.
go back to reference Maurice MJ, Zhu H, Kim S et al (2016) Survival after partial and radical nephrectomy for high-risk disease: a propensity-matched comparison. Can Urol Assoc J 10(9–10):E282–E289CrossRefPubMedPubMedCentral Maurice MJ, Zhu H, Kim S et al (2016) Survival after partial and radical nephrectomy for high-risk disease: a propensity-matched comparison. Can Urol Assoc J 10(9–10):E282–E289CrossRefPubMedPubMedCentral
20.
go back to reference Becker A, Hickmann D, Hansen J et al (2016) Critical analysis of a simplified Fuhrman grading scheme for prediction of cancer specific mortality in patients with clear cell renal cell carcinoma—impact on prognosis. Eur J Surg Oncol 42(3):419–425CrossRefPubMed Becker A, Hickmann D, Hansen J et al (2016) Critical analysis of a simplified Fuhrman grading scheme for prediction of cancer specific mortality in patients with clear cell renal cell carcinoma—impact on prognosis. Eur J Surg Oncol 42(3):419–425CrossRefPubMed
21.
go back to reference Pahernik S, Ziegler S, Roos F et al (2007) Small renal tumors: correlation of clinical and pathological features with tumor size. J Urol 178(2):414–417 (discussion 416–417) CrossRefPubMed Pahernik S, Ziegler S, Roos F et al (2007) Small renal tumors: correlation of clinical and pathological features with tumor size. J Urol 178(2):414–417 (discussion 416–417) CrossRefPubMed
22.
go back to reference Frank I, Blute ML, Cheville JC et al (2003) Solid renal tumors: an analysis of pathological features related to tumor size. J Urol 170(6 Pt 1):2217–2220CrossRefPubMed Frank I, Blute ML, Cheville JC et al (2003) Solid renal tumors: an analysis of pathological features related to tumor size. J Urol 170(6 Pt 1):2217–2220CrossRefPubMed
23.
go back to reference Bhindi B, Lohse CM, Mason RJ et al (2017) Are we using the best tumor size cut-points for renal cell carcinoma staging? Urology 109:121–126 Bhindi B, Lohse CM, Mason RJ et al (2017) Are we using the best tumor size cut-points for renal cell carcinoma staging? Urology 109:121–126
24.
go back to reference Kwon EO, Carver BS, Snyder ME et al (2007) Impact of positive surgical margins in patients undergoing partial nephrectomy for renal cortical tumours. BJU Int 99(2):286–289CrossRefPubMed Kwon EO, Carver BS, Snyder ME et al (2007) Impact of positive surgical margins in patients undergoing partial nephrectomy for renal cortical tumours. BJU Int 99(2):286–289CrossRefPubMed
25.
go back to reference Bensalah K, Pantuck AJ, Rioux-Leclercq N et al (2010) Positive surgical margin appears to have negligible impact on survival of renal cell carcinomas treated by nephron-sparing surgery. Eur Urol 57(3):466–471CrossRefPubMed Bensalah K, Pantuck AJ, Rioux-Leclercq N et al (2010) Positive surgical margin appears to have negligible impact on survival of renal cell carcinomas treated by nephron-sparing surgery. Eur Urol 57(3):466–471CrossRefPubMed
26.
go back to reference Yossepowitch O, Thompson RH, Leibovich BC et al (2008) Positive surgical margins at partial nephrectomy: predictors and oncological outcomes. J Urol 179(6):2158–2163CrossRefPubMedPubMedCentral Yossepowitch O, Thompson RH, Leibovich BC et al (2008) Positive surgical margins at partial nephrectomy: predictors and oncological outcomes. J Urol 179(6):2158–2163CrossRefPubMedPubMedCentral
27.
go back to reference Klein EA, Bianco FJ, Serio AM et al (2008) Surgeon experience is strongly associated with biochemical recurrence after radical prostatectomy for all preoperative risk categories. J Urol 179(6):2212–2216 (discussion 2216–2217) CrossRefPubMedPubMedCentral Klein EA, Bianco FJ, Serio AM et al (2008) Surgeon experience is strongly associated with biochemical recurrence after radical prostatectomy for all preoperative risk categories. J Urol 179(6):2212–2216 (discussion 2216–2217) CrossRefPubMedPubMedCentral
28.
go back to reference Rolevich A, Minich A, Nabebina T et al (2016) Surgeon has a major impact on long-term recurrence risk in patients with non-muscle invasive bladder cancer. Cent Eur J Urol 69(2):170–177 Rolevich A, Minich A, Nabebina T et al (2016) Surgeon has a major impact on long-term recurrence risk in patients with non-muscle invasive bladder cancer. Cent Eur J Urol 69(2):170–177
Metadata
Title
Does tumour effraction during robotic partial nephrectomy have any impact on recurrence?
Authors
Zine-Eddine Khene
Benoit Peyronnet
Benjamin Pradère
Corentin Robert
Anna Goujon
Solène-Florence Kammerer-Jacquet
Grégory Verhoest
Nathalie Rioux-Leclercq
Romain Mathieu
Karim Bensalah
Publication date
01-01-2019
Publisher
Springer Japan
Published in
International Journal of Clinical Oncology / Issue 1/2019
Print ISSN: 1341-9625
Electronic ISSN: 1437-7772
DOI
https://doi.org/10.1007/s10147-018-1331-2

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