Outcomes of high-complexity renal tumours with a Preoperative Aspects and Dimensions Used for an Anatomical (PADUA) score of ≥10 after robot-assisted partial nephrectomy with a median 46.5-month follow-up: a tertiary centre experience.
OBJECTIVE
To compare perioperative trifecta achievement and long-term oncological and functional outcomes between patients with renal tumours of low [Preoperative Aspects and Dimensions Used for an Anatomical (PADUA) score 6-7], intermediate (PADUA score 8-9) and high (PADUA score ≥10) complexity undergoing robot-assisted partial nephrectomy (RAPN), and to determine predictors for trifecta achievement.


METHODS
Data were retrospectively analysed from 295 patients, who underwent RAPN, between 2006 and 2015, at a high-volume tertiary centre. Trifecta achievement was the primary outcome measurement. The perioperative parameters and long-term oncological and functional outcomes were the secondary outcome measures. Groups were compared using the Kruskal-Wallis H test or chi-square test. Univariable and multivariable binary logistic regression analyses were used to determine the most important determinant variables associated with trifecta accomplishment. The Kaplan-Meier method was used to estimate overall survival (OS), cancer-specific survival (CSS) and cancer-free survival (CFS).


RESULTS
Of the 295 patients, 121 (41%) had a PADUA score of ≥10. Patients in the high-complexity PADUA group had larger tumours (P ≤ 0.001), higher clinical stages ≥T1b (P < 0.001), an increased risk of malignancy (P = 0.02), longer warm ischaemia time (P = 0.0030), and higher estimated blood loss (P = 0.001) compared with those in the intermediate- and low-complexity groups. Seven of eight patients who were converted to radical nephrectomy had high-complexity tumours (P = 0.02). Trifecta achievement was less in the high-complexity PADUA group (P < 0.001). Renal functional outcomes did not differ among the groups at follow-up (P > 0.05). There were no significant differences between the groups for OS (P = 0.314), CSS (P = 0.228) and CFS (P = 0.532). In multivariable analysis, the American Society of Anesthesiologists classification, operative time and tumour size were independent predictors of trifecta achievement (P = 0.001, P = 0.03, and P = 0.006, respectively).


CONCLUSIONS
High-complexity PADUA tumours are associated with a lower rate of trifecta achievement; however, long-term oncological and functional outcomes seem to be equivalent among high-, intermediate-, and low-complexity tumours. Despite the perioperative outcomes; high-complexity tumours can be handled successfully via the robotic approach and the improved long-term oncological and functional outcomes might be considered useful for patients counselling.
Department of Urology and Urological Science Institute, Yonsei University College of Medicine, Seoul, South Korea.|Department of Urology, Tanta University Medical School, Egypt.
Ali
A
Abdel Raheem
Department of Urology and Urological Science Institute, Yonsei University College of Medicine, Seoul, South Korea.
Atalla
A
Alatawi
Department of Urology, CHA Seoul Station Medical Center, CHA University Medical School, Seoul, South Korea.
Dae K
DK
Kim
Department of Urology and Urological Science Institute, Yonsei University College of Medicine, Seoul, South Korea.
Abulhasan
A
Sheikh
Department of Urology and Urological Science Institute, Yonsei University College of Medicine, Seoul, South Korea.
Ibrahim
I
Alabdulaali
Department of Urology and Urological Science Institute, Yonsei University College of Medicine, Seoul, South Korea.
Woong K
WK
Han
Department of Urology and Urological Science Institute, Yonsei University College of Medicine, Seoul, South Korea.
Young D
YD
Choi
Department of Urology and Urological Science Institute, Yonsei University College of Medicine, Seoul, South Korea. khrha@yuhs.ac.
Koon H
KH
Rha
D000368:Aged; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007680:Kidney Neoplasms / Q000473:pathology* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009392:Nephrectomy / Q000379:methods*; D011300:Preoperative Care; D012189:Retrospective Studies; D065287:Robotic Surgical Procedures; D062606:Tertiary Care Centers; D013997:Time Factors; D016896:Treatment Outcome
PADUA score; partial nephrectomy; robotic surgery