Robotic partial nephrectomy: imperative vs elective indications

Abstract

Objective: To assess the impact of imperative or elective indications on the perioperative outcomes of patients undergoing robotic partial nephrectomy.

Materials and methods: Between January 2008 and August 2011, 381 consecutive robotic partial nephrectomies were retrospectively included. Two groups of patients were identified: those who underwent the procedure for an imperative indication (n = 98) and those who underwent the procedure for an elective indication (n = 283). Perioperative and renal function outcomes were compared between the 2 groups. Multivariate analysis was performed to determine whether imperative indications were predictors of complications, chronic kidney disease stage upstaging, postoperative estimated glomerular filtration rate, and percentage of estimated glomerular filtration rate decrease.

Results: There were no differences between the 2 groups with respect to RENAL score and tumor size. Patients in the imperative group were more likely to have a higher Charlson Comorbidity Index score (6 vs 4, P < .001), higher chronic kidney disease stage (P < .001), and lower estimated glomerular filtration rate (61.9 vs 88.6 mL/min/1.73 m(2), P < .001). Perioperative outcomes were similar with respect to warm ischemia time, estimated blood loss, operative time, transfusion rate, positive surgical margin rate, and length of stay. Imperative indications were associated with higher major complication rate (7.22% vs 2.47%, P = .032), but not with overall (31.6% vs 26%, P = .62) and intraoperative complications (6.1% vs 3.2%, P = .22). In multivariate analysis, imperative indication was an independent predictor of postoperative estimated glomerular filtration rate but was not a predictor of percentage of estimated glomerular filtration rate decrease and chronic kidney disease upstaging.

Conclusion: Patients undergoing robotic partial nephrectomy for an imperative indication have similar functional outcomes than those with an elective indication. However, they are at higher risk of major complications.