Partial or radical nephrectomy for complex renal mass: a comparative analysis of oncological outcomes and complications from the ROSULA (Robotic Surgery for Large Renal Mass) Collaborative Group

Clara Cerrato; Devin Patel; Riccardo Autorino; Giuseppe Simone; Bo Yang; Robert Uzzo; Francesco Porpiglia; Umberto Capitanio; James Porter; Alp Tuna Beksac; Andrea Minervini; Alessandro Antonelli; Maria Angela Cerruto; Clayton Lau; Akbar Ashrafi; Daniel Eun; Alexandre Mottrie; Carmen Mir; Margaret F Meagher; Dhruv Puri; Mimi Nguyen; Sohail Dhanji; Franklin Liu; Savio D Pandolfo; Alexander Kutikov; Francesco Montorsi; Inderbir S Gill; Chandru Sundaram; Jihad Kaouk; Ithaar H Derweesh

doi:10.1007/s00345-023-04279-1

Partial or radical nephrectomy for complex renal mass: a comparative analysis of oncological outcomes and complications from the ROSULA (Robotic Surgery for Large Renal Mass) Collaborative Group

World J Urol. 2023 Mar;41(3):747-755. doi: 10.1007/s00345-023-04279-1. Epub 2023 Mar 1.

Authors

Clara Cerrato^{1

2}, Devin Patel¹, Riccardo Autorino^{3

4}, Giuseppe Simone⁵, Bo Yang⁶, Robert Uzzo⁷, Francesco Porpiglia⁸, Umberto Capitanio⁹, James Porter¹⁰, Alp Tuna Beksac¹¹, Andrea Minervini¹², Alessandro Antonelli², Maria Angela Cerruto², Clayton Lau¹³, Akbar Ashrafi¹⁴, Daniel Eun¹⁵, Alexandre Mottrie¹⁶, Carmen Mir¹⁷, Margaret F Meagher¹, Dhruv Puri¹, Mimi Nguyen¹, Sohail Dhanji¹, Franklin Liu¹, Savio D Pandolfo³, Alexander Kutikov⁷, Francesco Montorsi⁹, Inderbir S Gill¹⁴, Chandru Sundaram¹⁸, Jihad Kaouk¹¹, Ithaar H Derweesh¹⁹

Affiliations

¹ Department of Urology, UC San Diego School of Medicine, 3855 Health Sciences Drive, Mail Code 0987, La Jolla, CA, 92093-0987, USA.
² Department of Urology, University of Verona, Azienda Ospedaliera Universitaria Integrata, Verona, Italy.
³ Division of Urology, VCU Health System, Richmond, USA.
⁴ Department of Urology, Rush University School of Medicine, Chicago, USA.
⁵ Department of Urology, IRCCS-"Regina Elena" National Cancer Institute, Rome, Italy.
⁶ Department of Urology, Changhai Hospital, Shanghai, China.
⁷ Division of Urology and Urologic Oncology, Fox Chase Cancer Center, Philadelphia, USA.
⁸ Department of Urology, University of Turin-San Luigi Gonzaga Hospital, Turin, Italy.
⁹ Unit of Urology, IRCCS San Raffaele Scientific Institute, Urological Research Institute (URI) Division of Experimental Oncology, Vita-Salute San Raffaele, University, Milan, Italy.
¹⁰ Swedish Urology Group, Seattle, USA.
¹¹ Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, USA.
¹² Department of Urology, University of Florence, Florence, Italy.
¹³ Division of Urology and Urologic Oncology, City of Hope Medical Center, Duarte, USA.
¹⁴ Institute of Urology, University of Southern California Keck School of Medicine, Los Angeles, USA.
¹⁵ Department of Urology, Lewis Katz School of Medicine at Temple University, Philadelphia, USA.
¹⁶ Department of Urology, OLV Hospital, Aalst, Belgium.
¹⁷ Department of Urology, IMED Hospitals, Valencia, Spain.
¹⁸ Department of Urology, Indiana University Health, Indianapolis, USA.
¹⁹ Department of Urology, UC San Diego School of Medicine, 3855 Health Sciences Drive, Mail Code 0987, La Jolla, CA, 92093-0987, USA. [email protected].

PMID: 36856832
DOI: 10.1007/s00345-023-04279-1

Abstract

Purpose: To compare outcomes of robotic-assisted partial nephrectomy (RAPN) and minimally invasive radical nephrectomy (MIS-RN) for complex renal masses (CRM).

Methods: We conducted a retrospective multicenter analysis of CRM patients who underwent MIS-RN and RAPN. CRM was defined as RENAL score 10-12. Primary outcome was overall survival (OS). Secondary outcomes were cancer-specific survival (CSS), recurrence, and complications. Multivariable analysis (MVA) and Kaplan-Meier Analysis (KMA) were used to analyze functional and survival outcomes for RN vs. PN by pathological stage.

Results: 926 patients were analyzed (MIS-RN = 437/RAPN = 489; median follow-up 24.0 months). MVA demonstrated lack of transfusion (HR = 1.63, p = 0.005), low-grade (HR = 1.18, p = 0.018) and smaller tumor size (HR = 1.05, p < 0.001) were associated with OS. Younger age (HR = 1.01, p = 0.017), high-grade (HR = 1.18, p = 0.017), smaller tumor size (HR = 1.05, p < 0.001), and lack of transfusion (HR = 1.39, p = 0.038) were associated with CSS. Increasing tumor size (HR = 1.18, p < 0.001), high-grade (HR = 3.21, p < 0.001), and increasing age (HR = 1.02, p = 0.009) were independent risk factors for recurrence. Type of surgery was not associated with major complications (p = 0.094). For KMA of MIS-RN vs. RAPN for pT1, pT2 and pT3, 5-year OS was 85% vs. 88% (p = 0.078); 82% vs. 80% (p = 0.442) and 84% vs. 83% (p = 0.863), respectively. 5-year CSS was 98% for both procedures (p = 0.473); 94% vs. 92% (p = 0.735) and 91% vs. 90% (p = 0.581). 5-year non-CSS was 87% vs. 93% (p = 0.107); 87% for pT2 (p = 0.485) and 92% for pT3 for both procedures (p = 0.403).

Conclusion: RAPN in CRM is not associated with increased risk of complications or worsened oncological outcomes when compared to MIS-RN and may be preferred when clinically indicated.

Keywords: Carcinoma; Complex renal mass; Complications; Partial nephrectomy; Radical nephrectomy; Renal Cell; Survival analysis.

Publication types

Multicenter Study

MeSH terms

Carcinoma, Renal Cell* / pathology
Humans
Kidney Neoplasms* / pathology
Nephrectomy / methods
Retrospective Studies
Robotic Surgical Procedures* / methods
Treatment Outcome