title: Multicentre outcomes of robot-assisted partial nephrectomy after major open abdominal surgery.
abstract: OBJECTIVE
  To evaluate the outcomes of robot-assisted partial nephrectomy RAPN after major prior abdominal surgery (PAS) using a large multicentre database.
  
  
  METHODS
  We identified 1 686 RAPN from five academic centres between 2006 and 2014. In all, 216 patients had previously undergone major PAS, defined as having an open upper midline/ipsilateral incision. Perioperative outcomes were compared with those 1 470 patients who had had no major PAS. The chi-squared test and Mann-Whitney U-test were used for categorical and continuous variables, respectively.
  
  
  RESULTS
  There was no statistically significant difference in Charlson comorbidity index, tumour size, R.E.N.A.L. nephrometry score or preoperative estimated glomerular filtration rate (eGFR) between the groups. Age and body mass index were higher in patients with PAS. The PAS group had a higher estimated blood loss (EBL) but this did not lead to a higher transfusion rate. A retroperitoneal approach was used more often in patients with major PAS (11.2 vs 5.4%), although this group did not have a higher percentage of posterior tumours (38.8 vs 43.3%, P = 0.286). Operative time, warm ischaemia time, length of stay, positive surgical margin, percentage change in eGFR, and perioperative complications were not significantly different between the groups.
  
  
  CONCLUSIONS
  RAPN in patients with major PAS is safe and feasible, with increased EBL but no increased rate of transfusion. Patients with major PAS had almost twice the likelihood of having a retroperitoneal approach.
authors.affiliation: Vattikutti Urology Institute, Henry Ford Health System, Detroit, MI.
authors.forename: Newaj
authors.initials: N
authors.lastname: Abdullah
authors.affiliation: Vattikutti Urology Institute, Henry Ford Health System, Detroit, MI.
authors.forename: Haider
authors.initials: H
authors.lastname: Rahbar
authors.affiliation: Vattikutti Urology Institute, Henry Ford Health System, Detroit, MI.
authors.forename: Ravi
authors.initials: R
authors.lastname: Barod
authors.affiliation: Vattikutti Urology Institute, Henry Ford Health System, Detroit, MI.
authors.forename: Deepansh
authors.initials: D
authors.lastname: Dalela
authors.affiliation: Division of Urology, Washington University in St. Louis, St. Louis, MO, USA.
authors.forename: Jeff
authors.initials: J
authors.lastname: Larson
authors.affiliation: James Buchanan Brady Urological Institute, John Hopkins University, Baltimore, MD, USA.
authors.forename: Michael
authors.initials: M
authors.lastname: Johnson
authors.affiliation: Department of Urology, New York University, New York, NY, USA.
authors.forename: Alon
authors.initials: A
authors.lastname: Mass
authors.affiliation: Glickman Urological and Kidney Institute, Cleveland Clinic Foundation, Cleveland, OH, USA.
authors.forename: Homayoun
authors.identifier: http://orcid.org/0000-0001-8424-1087
authors.initials: H
authors.lastname: Zargar
authors.affiliation: James Buchanan Brady Urological Institute, John Hopkins University, Baltimore, MD, USA.
authors.forename: Mohamad
authors.initials: M
authors.lastname: Allaf
authors.affiliation: Division of Urology, Washington University in St. Louis, St. Louis, MO, USA.
authors.forename: Sam
authors.initials: S
authors.lastname: Bhayani
authors.affiliation: Department of Urology, New York University, New York, NY, USA.
authors.forename: Michael
authors.initials: M
authors.lastname: Stifelman
authors.affiliation: Glickman Urological and Kidney Institute, Cleveland Clinic Foundation, Cleveland, OH, USA.
authors.forename: Jihad
authors.initials: J
authors.lastname: Kaouk
authors.affiliation: Vattikutti Urology Institute, Henry Ford Health System, Detroit, MI.
authors.forename: Craig
authors.initials: C
authors.lastname: Rogers
mesh_terms: D000005:Abdomen / Q000601:surgery*; D000368:Aged; D001803:Blood Transfusion; D005260:Female; D006801:Humans; D007680:Kidney Neoplasms / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009392:Nephrectomy / Q000379:methods*; D012189:Retrospective Studies; D065287:Robotic Surgical Procedures; D016896:Treatment Outcome
keywords: prior abdominal surgery; robotic partial nephrectomy; surgical outcomes