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Predictors for trifecta achievement of robot‐assisted partial nephrectomy in high‐complexity tumors (Preoperative Aspects and Dimensions Used for an Anatomical score ≥10)
INTRODUCTION: Robot‐assisted partial nephrectomy (RAPN) is emerging as an effective treatment oncologically and functionally for clinically localized renal tumors. However, RAPN in high‐complexity tumors with a Preoperative Aspects and Dimensions Used for an Anatomical score ≥10 remains challenging....
Autores principales: | , , , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
John Wiley & Sons Australia, Ltd
2019
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7384074/ https://www.ncbi.nlm.nih.gov/pubmed/31823487 http://dx.doi.org/10.1111/ases.12767 |
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author | Takahara, Kiyoshi Sumitomo, Makoto Fukaya, Kosuke Jyoudai, Takahito Nishino, Masashi Hikichi, Masaru Nukaya, Takuhisa Zennami, Kenji Ichino, Manabu Fukami, Naohiko Sasaki, Hitomi Kusaka, Mamoru Shiroki, Ryoichi |
author_facet | Takahara, Kiyoshi Sumitomo, Makoto Fukaya, Kosuke Jyoudai, Takahito Nishino, Masashi Hikichi, Masaru Nukaya, Takuhisa Zennami, Kenji Ichino, Manabu Fukami, Naohiko Sasaki, Hitomi Kusaka, Mamoru Shiroki, Ryoichi |
author_sort | Takahara, Kiyoshi |
collection | PubMed |
description | INTRODUCTION: Robot‐assisted partial nephrectomy (RAPN) is emerging as an effective treatment oncologically and functionally for clinically localized renal tumors. However, RAPN in high‐complexity tumors with a Preoperative Aspects and Dimensions Used for an Anatomical score ≥10 remains challenging. In this study, the feasibility of RAPN for high‐complexity tumors was assessed. METHODS: The study cohort consisted of 177 cases with clinically localized renal cell carcinoma who had undergone RAPN at our hospital from July 2010 to February 2018. They were assessed for perioperative parameters and trifecta achievement (ie, negative surgical margins, warm ischemia time <25 minutes, and no complications). RESULTS: Among the 177 cases who had undergone RAPN, 60 had high‐complexity tumors, and 117 had non‐high‐complexity (ie, intermediate‐ or low‐complexity) tumors. There were no significant differences in the operative and console times between the cohorts, but estimated intraoperative blood loss was much lower in the non‐high‐complexity group. Although the average warm ischemia time was less than 25 minutes in both groups, it was significantly shorter in the non‐high‐complexity group. Trifecta achievement rates significantly differed between the high‐ and non‐high‐complexity groups (68.3% vs 86.3%). Comparisons of four operative parameters (ie, BMI, tumor size, endophytic properties, and hilar tumor) using univariate analysis in the 60 high‐complexity tumor cases showed that BMI and tumor size were independent factors (P = 0.05 and 0.018, respectively). In multivariate analysis, tumor size was the only factor directly associated with trifecta achievement (P = 0.029). CONCLUSION: The trifecta achievement rate was significantly lower in the high‐complexity group. Only tumor size affected trifecta achievement during RAPN in cases with high‐complexity tumors (Preoperative Aspects and Dimensions Used for an Anatomical score ≥10). |
format | Online Article Text |
id | pubmed-7384074 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2019 |
publisher | John Wiley & Sons Australia, Ltd |
record_format | MEDLINE/PubMed |
spelling | pubmed-73840742020-07-28 Predictors for trifecta achievement of robot‐assisted partial nephrectomy in high‐complexity tumors (Preoperative Aspects and Dimensions Used for an Anatomical score ≥10) Takahara, Kiyoshi Sumitomo, Makoto Fukaya, Kosuke Jyoudai, Takahito Nishino, Masashi Hikichi, Masaru Nukaya, Takuhisa Zennami, Kenji Ichino, Manabu Fukami, Naohiko Sasaki, Hitomi Kusaka, Mamoru Shiroki, Ryoichi Asian J Endosc Surg Original Articles INTRODUCTION: Robot‐assisted partial nephrectomy (RAPN) is emerging as an effective treatment oncologically and functionally for clinically localized renal tumors. However, RAPN in high‐complexity tumors with a Preoperative Aspects and Dimensions Used for an Anatomical score ≥10 remains challenging. In this study, the feasibility of RAPN for high‐complexity tumors was assessed. METHODS: The study cohort consisted of 177 cases with clinically localized renal cell carcinoma who had undergone RAPN at our hospital from July 2010 to February 2018. They were assessed for perioperative parameters and trifecta achievement (ie, negative surgical margins, warm ischemia time <25 minutes, and no complications). RESULTS: Among the 177 cases who had undergone RAPN, 60 had high‐complexity tumors, and 117 had non‐high‐complexity (ie, intermediate‐ or low‐complexity) tumors. There were no significant differences in the operative and console times between the cohorts, but estimated intraoperative blood loss was much lower in the non‐high‐complexity group. Although the average warm ischemia time was less than 25 minutes in both groups, it was significantly shorter in the non‐high‐complexity group. Trifecta achievement rates significantly differed between the high‐ and non‐high‐complexity groups (68.3% vs 86.3%). Comparisons of four operative parameters (ie, BMI, tumor size, endophytic properties, and hilar tumor) using univariate analysis in the 60 high‐complexity tumor cases showed that BMI and tumor size were independent factors (P = 0.05 and 0.018, respectively). In multivariate analysis, tumor size was the only factor directly associated with trifecta achievement (P = 0.029). CONCLUSION: The trifecta achievement rate was significantly lower in the high‐complexity group. Only tumor size affected trifecta achievement during RAPN in cases with high‐complexity tumors (Preoperative Aspects and Dimensions Used for an Anatomical score ≥10). John Wiley & Sons Australia, Ltd 2019-12-10 2020-07 /pmc/articles/PMC7384074/ /pubmed/31823487 http://dx.doi.org/10.1111/ases.12767 Text en © 2019 The Authors. Asian Journal of Endoscopic Surgery published by Asia Endosurgery Task Force and Japan Society of Endoscopic Surgery and John Wiley & Sons Australia, Ltd. This is an open access article under the terms of the http://creativecommons.org/licenses/by/4.0/ License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited. |
spellingShingle | Original Articles Takahara, Kiyoshi Sumitomo, Makoto Fukaya, Kosuke Jyoudai, Takahito Nishino, Masashi Hikichi, Masaru Nukaya, Takuhisa Zennami, Kenji Ichino, Manabu Fukami, Naohiko Sasaki, Hitomi Kusaka, Mamoru Shiroki, Ryoichi Predictors for trifecta achievement of robot‐assisted partial nephrectomy in high‐complexity tumors (Preoperative Aspects and Dimensions Used for an Anatomical score ≥10) |
title | Predictors for trifecta achievement of robot‐assisted partial nephrectomy in high‐complexity tumors (Preoperative Aspects and Dimensions Used for an Anatomical score ≥10) |
title_full | Predictors for trifecta achievement of robot‐assisted partial nephrectomy in high‐complexity tumors (Preoperative Aspects and Dimensions Used for an Anatomical score ≥10) |
title_fullStr | Predictors for trifecta achievement of robot‐assisted partial nephrectomy in high‐complexity tumors (Preoperative Aspects and Dimensions Used for an Anatomical score ≥10) |
title_full_unstemmed | Predictors for trifecta achievement of robot‐assisted partial nephrectomy in high‐complexity tumors (Preoperative Aspects and Dimensions Used for an Anatomical score ≥10) |
title_short | Predictors for trifecta achievement of robot‐assisted partial nephrectomy in high‐complexity tumors (Preoperative Aspects and Dimensions Used for an Anatomical score ≥10) |
title_sort | predictors for trifecta achievement of robot‐assisted partial nephrectomy in high‐complexity tumors (preoperative aspects and dimensions used for an anatomical score ≥10) |
topic | Original Articles |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7384074/ https://www.ncbi.nlm.nih.gov/pubmed/31823487 http://dx.doi.org/10.1111/ases.12767 |
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