Long-Term Oncologic Outcomes After Laparoscopic and Robotic Tumor Enucleation for Renal Cell Carcinoma

Wen Dong; Xiong Chen; Ming Huang; Xu Chen; Ming Gao; Dehua Ou; Kaiwen Li; Chenyang Wang; Shaoxu Wu; Hao Liu; Weibin Xie; Wenlian Xie; Steven C Campbell; Tianxin Lin; Jian Huang

doi:10.3389/fonc.2020.595457

Long-Term Oncologic Outcomes After Laparoscopic and Robotic Tumor Enucleation for Renal Cell Carcinoma

Front Oncol. 2021 Jan 14:10:595457. doi: 10.3389/fonc.2020.595457. eCollection 2020.

Authors

Wen Dong¹, Xiong Chen¹, Ming Huang¹, Xu Chen¹, Ming Gao², Dehua Ou¹, Kaiwen Li¹, Chenyang Wang¹, Shaoxu Wu¹, Hao Liu¹, Weibin Xie¹, Wenlian Xie¹, Steven C Campbell³, Tianxin Lin¹, Jian Huang¹

Affiliations

¹ Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Department of Urology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China.
² Department of Radiology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China.
³ Department of Urology, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, United States.

Abstract

Objectives: Tumor enucleation (TE) optimizes parenchymal preservation with promising short-term oncologic outcomes compared with standard partial nephrectomy (SPN). However, researches/literatures about long-term oncologic outcomes for TE after minimally invasive surgery are scarce. We aim to analyze long-term oncologic outcomes after laparoscopic and robotic tumor enucleation for renal cell carcinoma (RCC).

Patients and methods: We retrospectively analyzed 146 patients who underwent TE with either laparoscopic or robotic approach for localized RCC in our center. Local recurrence, cancer specific survival (CSS), recurrence free survival (RFS), and overall survival (OS) were the main outcomes. Survival curves were generated using a Kaplan-Meier method. Perioperative outcomes and pathological outcomes were also analyzed.

Results: Overall, 98 male and 48 female patients were eligible for the study. The median tumor size was 3.4 cm with a median R.E.N.A.L. score of seven. Warm ischemia was used in 143 patients with a median ischemia time of 20 min and three patients had zero ischemia. Five patients (3.4%) had major complications (> Clavien IIIa) and only two were related to urinary system. The median global glomerular filtration rate (GFR) preserved after surgery was 93%. Pseudocapsule invasion was reported in 50 tumors (34%) and positive surgical margins were found in 3/146 (2.1%) tumors. At a median follow-up of 66 months, local recurrence happened in two patients (1.4%), and systemic recurrence happened in six patients (4.2%). The 5-year CSS, RFS, OS were 95.7, 89.6, and 91.9%, and the 10-year CSS, RFS, OS were 93.8, 89.6, and 90.0%, respectively.

Conclusion: This study indicates that tumor enucleation with laparoscopic or robotic approach in experienced hands for the treatment of RCC appears oncologically safe with a median follow-up of more than 5 years. Prospective studies with more patients and longer follow-up will be required to further evaluate oncologic safety after TE.

Keywords: follow-up; nephron sparing surgery; renal cell carcinoma; survival; tumor enucleation.