Transperitoneal vs retroperitoneal minimally invasive partial nephrectomy: comparison of perioperative outcomes and functional follow-up in a large multi-institutional cohort (The RECORD 2 Project)

Autor: Vincenzo Altieri, Daniele Amparore, Riccardo Rizzetto, Alessandro Larcher, Sergio Serni, G. Grosso, Cesare Selli, Matteo Ferro, Giuseppe Vespasiani, Bernardo Rocco, Alchiede Simonato, Nicola Longo, Luigi Schips, Marco Carini, Angelo Porreca, Francesco Berardinelli, Salvatore Siracusano, Carlo Terrone, Mario Falsaperla, A. Volpe, Antonio Celia, F. Di Maida, Umberto Capitanio, R. Tellini, Carlo Trombetta, Claudio Simeone, Alessandro Antonelli, A. Diminutto, V. Li Marzi, Francesco Porpiglia, Giancarlo Marra, P. Bove, Donata Villari, F. Montorsi, L. Da Pozzo, Eugenio Brunocilla, A. Polara, Andrea Minervini, Maria Furlan, Vincenzo Ficarra, M. Roscigno, P. Gontero, Elisabetta Costantini, Walter Artibani, Carla Fiori, Riccardo Schiavina, Andrea Mari
Přispěvatelé: Porpiglia, F., Mari, A., Amparore, D., Fiori, C., Antonelli, A., Artibani, W., Bove, P., Brunocilla, E., Capitanio, U., Da Pozzo, L., Di Maida, F., Gontero, P., Longo, N., Marra, G., Rocco, B., Schiavina, R., Simeone, C., Siracusano, S., Tellini, R., Terrone, C., Villari, D., Ficarra, V., Carini, M., Minervini, A., Altieri, V., Berardinelli, F., Celia, A., Costantini, E., Diminutto, A., Falsaperla, M., Ferro, M., Furlan, M., Grosso, G., Larcher, A., Li Marzi, V., Montorsi, F., Polara, A., Porreca, A., Rizzetto, R., Roscigno, M., Schips, L., Selli, C., Serni, S., Simonato, A., Trombetta, C., Vespasiani, G., Volpe, A., Francesco Porpiglia, Andrea Mari, Daniele Amparore, Cristian Fiori, Alessandro Antonelli, Walter Artibani, Pierluigi Bove, Eugenio Brunocilla, Umberto Capitanio, Luigi Da Pozzo, Fabrizio Di Maida, Paolo Gontero, Nicola Longo, Giancarlo Marra, Bernardo Rocco, Riccardo Schiavina, Claudio Simeone, Salvatore Siracusano, Riccardo Tellini, Carlo Terrone, Donata Villari, Vincenzo Ficarra, Marco Carini, Andrea Minervini, Vincenzo Altieri, Francesco Berardinelli, Antonio Celia, Elisabetta Costantini, Alberto Diminutto, Mario Falsaperla, Matteo Ferro, Maria Furlan, Gaetano Grosso, Alessandro Larcher, Vincenzo Li Marzi, Francesco Montorsi, Andrea Polara, Angelo Porreca, Riccardo Rizzetto, Marco Roscigno, Luigi Schip, Cesare Selli, Sergio Serni, Alchiede Simonato, Carlo Trombetta, Giuseppe Vespasiani, Alessandro Volpe, Porpiglia F., Mari A., Amparore D., Fiori C., Antonelli A., Artibani W., Bove P., Brunocilla E., Capitanio U., Da Pozzo L., Di Maida F., Gontero P., Longo N., Marra G., Rocco B., Schiavina R., Simeone C., Siracusano S., Tellini R., Terrone C., Villari D., Ficarra V., Carini M., Minervini A., Altieri V., Berardinelli F., Celia A., Costantini E., Diminutto A., Falsaperla M., Ferro M., Furlan M., Grosso G., Larcher A., Li Marzi V., Montorsi F., Polara A., Porreca A., Rizzetto R., Roscigno M., Schips L., Selli C., Serni S., Simonato A., Trombetta C., Vespasiani G., Volpe A.
Rok vydání: 2020
Předmět:
medicine.medical_specialty
Intraoperative Complication
Urology
medicine.medical_treatment
Operative Time
Surgical approach
030232 urology & nephrology
Minimally invasive partial nephrectomy
Renal cell carcinoma
Retroperitoneal
Surgical approach
Transperitoneal
lcsh:RC870-923
lcsh:RC254-282
Nephrectomy
Article
03 medical and health sciences
0302 clinical medicine
Renal cell carcinoma
medicine
Minimally invasive partial nephrectomy
Retroperitoneal
Transperitoneal
Humans
Retroperitoneal Space
Retrospective Studies
business.industry
Perioperative
lcsh:Diseases of the genitourinary system. Urology
lcsh:Neoplasms. Tumors. Oncology. Including cancer and carcinogens
medicine.disease
Kidney Neoplasms
Surgery
Settore MED/24
Treatment Outcome
030220 oncology & carcinogenesis
Propensity score matching
Cohort
Laparoscopy
Positive Surgical Margin
Follow-Up Studies
business
Abdominal surgery
Zdroj: Surgical Endoscopy
European Urology Open Science, Vol 20, Iss, Pp S106-(2020)
ISSN: 1432-2218
Popis: Background Aim of this study was to evaluate and compare perioperative outcomes of transperitoneal (TP) and retroperitoneal (TR) approaches in a multi-institutional cohort of minimally invasive partial nephrectomy (MI-PN). Material and methods All consecutive patients undergone MI-PN for clinical T1 renal tumors at 26 Italian centers (RECORd2 project) between 01/2013 and 12/2016 were evaluated, collecting the pre-, intra-, and postoperative data. The patients were then stratified according to the surgical approach, TP or RP. A 1:1 propensity score (PS) matching was performed to obtain homogeneous cohorts, considering the age, gender, baseline eGFR, surgical indication, clinical diameter, and PADUA score. Results 1669 patients treated with MI-PN were included in the study, 1256 and 413 undergoing TP and RP, respectively. After 1:1 PS matching according to the surgical access, 413 patients were selected from TP group to be compared with the 413 RP patients. Concerning intraoperative variables, no differences were found between the two groups in terms of surgical approach (lap/robot), extirpative technique (enucleation vs standard PN), hilar clamping, and ischemia time. Conversely, the TP group recorded a shorter median operative time in comparison with the RP group (115 vs 150 min), with a higher occurrence of intraoperative overall, 21 (5.0%) vs 9 (2.1%); p = 0.03, and surgical complications, 18 (4.3%) vs 7 (1.7%); p = 0.04. Concerning postoperative variables, the two groups resulted comparable in terms of complications, positive surgical margins and renal function, even if the RP group recorded a shorter median drainage duration and hospital length of stay (3 vs 2 for both variables), p Conclusions The results of this study suggest that both TP and RP are feasible approaches when performing MI-PN, irrespectively from tumor location or surgical complexity. Notwithstanding longer operative times, RP seems to have a slighter intraoperative complication rate with earlier postoperative recovery when compared with TP.
Databáze: OpenAIRE
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