Experience of robot-assisted laparoscopic partial nephrectomy for renal tumorswith R.E.N.A.L.score ≥10

Wang Jie; Liang Xiaolong; Wu Zhenjie; Liu Jiayi; Shi Jiazi; Wang Weiping; Bao Yi; Ye Huamao; Lyu Chen; Xu Chuanliang; SunYinghao; HeYi; LiuBing; WangLinhui

doi:10.19558/j.cnki.10-1020/r.2017.01.003

Abstract：Objective:To evaluate the safety,feasibility and efficacy of robot-assisted laparoscopic partial ne-phrectomy (RAPN)in treating renal tumors with R.E.N.A.L.score ≥10.Methods:All patients receiving RAPN by the same surgeon during May 2012 and Feb 2016 were reviewed.Among them,38 patients with high complex renal tumors (R.E.N.A.L.score ≥10)were enrolled in this study.The male/female ratio was 26/12 with a mean age of 51.0±11.9 (19-72)years.The mean body mass index was 25.2±3.4 (19.6-35.2)kg/m2 ,and the mean ASA score was 1.91±1.03 (1 to 2). All tumors were solitary including 16 on the left and 22 on the right.The mean diameter was 4.27±2.27 (2-16)cm.There were 31 cases and 7 cases with R.E.N.A.L.score 10 points and 11 points respectively.The mean preoperative estimated glomerular filtration rate was 97.9±24.3 (69.8-131.4) mL?min-1?1.73 m-2 .Results:All procedures were completed successfully except one conversion to open sur-gery for intraoperative bleeding.The mean operation time was 208.8±46.5 (105-308)min,ischemia time was 26.6±7.4 (14-49)min,and estimated blood loss was 150.3±115.5 (10-600)mL.The mean postoperative hos-pital stay was 14.4±3.6 (9-25)days.The overall rate of blood transfusion was 5.3% (2/38)and the complica-tion rate was 7.9% (3/38).No positive surgical margin was observed.Postoperative pathology results revealed 32 renal clear cell carcinomas,1 chromophobe renal cell carcinoma,1 TFE-3 fusion gene related renal cell carcinoma renal cell carcinoma and 4 angiomyolipomas.The meane eGFR decreased by 7.1% three months after operation with a significant difference compared to preoperativee eGFR (P<0.004).All patients had no local recurrence or distant metastasis during a mean follow-up period of 27.8±9.7 (9-51)months.Conclusions:Robot-assisted lapa-roscopic partial nephrectomy is safe and effective for high-complexity renal tumors with R.E.N.A.L.≥10.