Margin, ischemia, and complications system to report perioperative outcomes of robotic partial nephrectomy: a European Multicenter Observational Study (EMOS project).
OBJECTIVE
To explore the margin, ischemia, and complications (MIC) system achievement rate within a population of patients who were treated with robotic partial nephrectomy (RAPN), at 3 different tertiary care centers, and to determine the factors predicting MIC achievement.


METHODS
The study population consisted of 339 patients who underwent RAPN for cT1 renal tumors at 3 centers. Cancer control was defined as the absence of positive surgical margin. Ideal threshold of warm ischemia time (WIT) was considered ≤20 minutes. Safety was defined as the absence of major complications. The achievement of MIC was considered as the fulfillment of all these 3 outcomes. The primary endpoint was to determine the MIC rate in our study population; the secondary endpoint was to detect factors affecting its achievement.


RESULTS
The overall MIC rate was 67%. Median WIT was 17 minutes (range, 7-51 minutes). In 88 cases (26%), WIT was >20 minutes. Positive surgical margins were found in 22 patients (6.5%). Overall postoperative and major complication rates were 14.5% (n = 49) and 3.8% (n = 13). In multivariate logistic regression analysis, continuously coded and categorically coded preoperative aspects and dimensions used for an anatomical scores were an independent predictor of MIC achievement (odds ratio, 0.636; confidence interval, 0.436-0.928; P = .019 and odds ratio, 0.098; confidence interval, 0.030-0.326; P <.001).


CONCLUSIONS
The MIC binary system may represent a useful tool to summarize the achievement of optimal perioperative outcomes of RAPN. In the current population, tumor complexity was significantly associated with MIC achievement.
Division of Oncology, Unit of Urology, URI, IRCCS Ospedale San Raffaele Turro, Universitá Vita-Salute San Raffaele, Milan, Italy. Electronic address: giulianalista@gmail.com.
Giuliana
G
Lista
Division of Oncology, Unit of Urology, URI, IRCCS Ospedale San Raffaele Turro, Universitá Vita-Salute San Raffaele, Milan, Italy.
Nicolò Maria
NM
Buffi
Division of Oncology, Unit of Urology, URI, IRCCS Ospedale San Raffaele Turro, Universitá Vita-Salute San Raffaele, Milan, Italy.
Giovanni
G
Lughezzani
Division of Oncology, Unit of Urology, URI, IRCCS Ospedale San Raffaele Turro, Universitá Vita-Salute San Raffaele, Milan, Italy.
Massimo
M
Lazzeri
Division of Oncology, Unit of Urology, URI, IRCCS Ospedale San Raffaele Turro, Universitá Vita-Salute San Raffaele, Milan, Italy.
Alberto
A
Abrate
Division of Oncology, Unit of Urology, URI, IRCCS Ospedale San Raffaele Turro, Universitá Vita-Salute San Raffaele, Milan, Italy.
Alessandro
A
Mistretta
Division of Oncology, Unit of Urology, URI, IRCCS Ospedale San Raffaele Turro, Universitá Vita-Salute San Raffaele, Milan, Italy.
Alessandro
A
Larcher
Division of Oncology, Unit of Urology, URI, IRCCS Ospedale San Raffaele Turro, Universitá Vita-Salute San Raffaele, Milan, Italy.
Paolo
P
Dell'Oglio
Division of Oncology, Unit of Urology, URI, IRCCS Ospedale San Raffaele Turro, Universitá Vita-Salute San Raffaele, Milan, Italy.
Nicola
N
Fossati
Swedish Urology Group, Seattle, WA.
James
J
Porter
Division of Urology, OLV Vattikuti Robotic Surgery Institute, Aalst, Belgium.
Vincenzo
V
Ficarra
Division of Urology, OLV Vattikuti Robotic Surgery Institute, Aalst, Belgium.
Alexander
A
Mottrie
Division of Oncology, Unit of Urology, URI, IRCCS Ospedale San Raffaele Turro, Universitá Vita-Salute San Raffaele, Milan, Italy.
Giorgio
G
Guazzoni
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005060:Europe; D005260:Female; D006801:Humans; D007680:Kidney Neoplasms / Q000473:pathology* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009392:Nephrectomy / Q000009:adverse effects* / Q000379:methods*; D011446:Prospective Studies; D065287:Robotic Surgical Procedures / Q000009:adverse effects*; D016896:Treatment Outcome; D052096:Warm Ischemia