Pouriya Faraj Tabrizi, Philip Zeuschner, Olga Katzendorn, Frank Schiefelbein, Andreas Schneller, Georg Schoen, Burkhard Ubrig, Simon Gloger, Clemens G Wiesinger, Jacob Pfuner, Eva Falkensammer, Ahmed Eraky, Daniar Osmonov, Philipp Nuhn, Volker Zimmermanns, Ionna Paramythelli, Boris A Hadaschik, Jan P Radtke, Christopher Darr, Nils Gilbert, Maximilian Kriegmair, Christian Fuhrmann, Markus A Kuczyk, Nina N Harke
{"title":"多发性肿瘤的机器人辅助肾部分切除术：多中心分析。","authors":"Pouriya Faraj Tabrizi, Philip Zeuschner, Olga Katzendorn, Frank Schiefelbein, Andreas Schneller, Georg Schoen, Burkhard Ubrig, Simon Gloger, Clemens G Wiesinger, Jacob Pfuner, Eva Falkensammer, Ahmed Eraky, Daniar Osmonov, Philipp Nuhn, Volker Zimmermanns, Ionna Paramythelli, Boris A Hadaschik, Jan P Radtke, Christopher Darr, Nils Gilbert, Maximilian Kriegmair, Christian Fuhrmann, Markus A Kuczyk, Nina N Harke","doi":"10.23736/S2724-6051.24.05816-6","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Robot-assisted partial nephrectomy (RAPN) is increasingly performed in challenging tumor constellations like multiple renal masses.</p><p><strong>Methods: </strong>The objective was to investigate influencing factors on postoperative renal function (PRF) after ipsilateral robot-assisted partial nephrectomy of multiple tumors (iRAPN-MT). In this retrospective multicenter study, perioperative data of 132 trans- or retroperitoneal iRAPN-MT for ≥ two tumors were analyzed focusing on influencing factors on PRF and acute kidney injury including RIFLE and trifecta criteria. The impact of patient-, surgery- and tumor-related factors was investigated via uni- and multivariate regression analyses.</p><p><strong>Results: </strong>The majority of patients had two renal masses, with three or more lesions in 19%. Median operative time was 175 minutes. Eighty-five percent of the tumors were dissected on-clamp with a median cumulative warm ischemia time (WIT<inf>sum</inf>) of 15 minutes. Trifecta criteria were fulfilled in 57%. In regression analyses, WIT<inf>sum</inf>, BMI and preoperative eGFR had an impact on eGFR loss before discharge (median -11.6 mL/min). BMI and Charlson Comorbidity Index were independent predictors for the lowest RIFLE stage during hospitalization.</p><p><strong>Conclusions: </strong>iRAPN-MT for multiple ipsilateral renal masses is feasible with good trifecta rates. While mostly unmodifiable patient-associated parameters were independent predictors on PRF impairment, WIT<inf>sum</inf> was identified as a surgery-related independent parameter.</p>","PeriodicalId":53228,"journal":{"name":"Minerva Urology and Nephrology","volume":" ","pages":"698-707"},"PeriodicalIF":4.9000,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Robot-assisted partial nephrectomy of multiple tumors: a multicenter analysis.\",\"authors\":\"Pouriya Faraj Tabrizi, Philip Zeuschner, Olga Katzendorn, Frank Schiefelbein, Andreas Schneller, Georg Schoen, Burkhard Ubrig, Simon Gloger, Clemens G Wiesinger, Jacob Pfuner, Eva Falkensammer, Ahmed Eraky, Daniar Osmonov, Philipp Nuhn, Volker Zimmermanns, Ionna Paramythelli, Boris A Hadaschik, Jan P Radtke, Christopher Darr, Nils Gilbert, Maximilian Kriegmair, Christian Fuhrmann, Markus A Kuczyk, Nina N Harke\",\"doi\":\"10.23736/S2724-6051.24.05816-6\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>Robot-assisted partial nephrectomy (RAPN) is increasingly performed in challenging tumor constellations like multiple renal masses.</p><p><strong>Methods: </strong>The objective was to investigate influencing factors on postoperative renal function (PRF) after ipsilateral robot-assisted partial nephrectomy of multiple tumors (iRAPN-MT). In this retrospective multicenter study, perioperative data of 132 trans- or retroperitoneal iRAPN-MT for ≥ two tumors were analyzed focusing on influencing factors on PRF and acute kidney injury including RIFLE and trifecta criteria. The impact of patient-, surgery- and tumor-related factors was investigated via uni- and multivariate regression analyses.</p><p><strong>Results: </strong>The majority of patients had two renal masses, with three or more lesions in 19%. Median operative time was 175 minutes. Eighty-five percent of the tumors were dissected on-clamp with a median cumulative warm ischemia time (WIT<inf>sum</inf>) of 15 minutes. Trifecta criteria were fulfilled in 57%. In regression analyses, WIT<inf>sum</inf>, BMI and preoperative eGFR had an impact on eGFR loss before discharge (median -11.6 mL/min). BMI and Charlson Comorbidity Index were independent predictors for the lowest RIFLE stage during hospitalization.</p><p><strong>Conclusions: </strong>iRAPN-MT for multiple ipsilateral renal masses is feasible with good trifecta rates. While mostly unmodifiable patient-associated parameters were independent predictors on PRF impairment, WIT<inf>sum</inf> was identified as a surgery-related independent parameter.</p>\",\"PeriodicalId\":53228,\"journal\":{\"name\":\"Minerva Urology and Nephrology\",\"volume\":\" \",\"pages\":\"698-707\"},\"PeriodicalIF\":4.9000,\"publicationDate\":\"2024-12-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Minerva Urology and Nephrology\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.23736/S2724-6051.24.05816-6\",\"RegionNum\":2,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"2024/11/28 0:00:00\",\"PubModel\":\"Epub\",\"JCR\":\"Q1\",\"JCRName\":\"UROLOGY & NEPHROLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Minerva Urology and Nephrology","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.23736/S2724-6051.24.05816-6","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2024/11/28 0:00:00","PubModel":"Epub","JCR":"Q1","JCRName":"UROLOGY & NEPHROLOGY","Score":null,"Total":0}
Robot-assisted partial nephrectomy of multiple tumors: a multicenter analysis.
Background: Robot-assisted partial nephrectomy (RAPN) is increasingly performed in challenging tumor constellations like multiple renal masses.
Methods: The objective was to investigate influencing factors on postoperative renal function (PRF) after ipsilateral robot-assisted partial nephrectomy of multiple tumors (iRAPN-MT). In this retrospective multicenter study, perioperative data of 132 trans- or retroperitoneal iRAPN-MT for ≥ two tumors were analyzed focusing on influencing factors on PRF and acute kidney injury including RIFLE and trifecta criteria. The impact of patient-, surgery- and tumor-related factors was investigated via uni- and multivariate regression analyses.
Results: The majority of patients had two renal masses, with three or more lesions in 19%. Median operative time was 175 minutes. Eighty-five percent of the tumors were dissected on-clamp with a median cumulative warm ischemia time (WITsum) of 15 minutes. Trifecta criteria were fulfilled in 57%. In regression analyses, WITsum, BMI and preoperative eGFR had an impact on eGFR loss before discharge (median -11.6 mL/min). BMI and Charlson Comorbidity Index were independent predictors for the lowest RIFLE stage during hospitalization.
Conclusions: iRAPN-MT for multiple ipsilateral renal masses is feasible with good trifecta rates. While mostly unmodifiable patient-associated parameters were independent predictors on PRF impairment, WITsum was identified as a surgery-related independent parameter.
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