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Long-Term Oncological and Functional Outcomes After Robot-Assisted Partial Nephrectomy for Clinically Localized Renal Cell Carcinoma

  • Urologic Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

To evaluate long-term oncological and renal function outcomes in patients treated with robot-assisted partial nephrectomy (RAPN) for renal cell carcinoma (RCC).

Patients and Methods

Patients undergoing RAPN for clinically localized RCC between January 2014 and December 2019 at a tertiary robotic reference center were evaluated. Clinical course, pathologic characteristics, and long-term outcomes were obtained from our institutional review board-approved RCC database.

Results

A total of 234 patients were available for analysis. Median follow-up was 46 months (10.8–97.8 months), with 77 patients (32.9%) having at least 5-years of follow-up. Pathology revealed clear-cell RCC in 67.5% (n = 158). Among unfavorable factors, nuclear grades 3 or 4 were found in 67 (29.4%), lymphovascular invasion in 10 (4.3%), positive surgical margins in 22 (9.4%), necrosis in 21 (9%), and sarcomatoid pattern in 2 patients (0.9%). At 12 months, mean serum creatinine was 1.04 mg/dL and 12.9% of patients experienced upstaging in chronic kidney disease. Overall recurrence-free survival at 5-years was 97.8%. There were five local (2.1%) and two distant (0.9%) recurrences, none of them resulting in cancer-specific death. Median time to recurrence was 20 months (11–64 months). Warm ischemia time [hazard ratio (HR) = 1.14, p = 0.034] and sarcomatoid pattern (HR = 124.57, p = 0.001) were the only variables associated with local relapse.

Conclusions

Data from this large cohort demonstrate that patients undergoing RAPN have a low incidence of local and distant relapse, resulting in excellent long-term survival while preserving stable renal function in most patients.

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Funding

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Authors and Affiliations

  1. Department of Urology, Clínica Alemana de Santiago, Santiago, Chile

    Hugo Otaola-Arca MD, PhD, Alfred Krebs MD, Hugo Bermúdez MD, Raúl Lyng MD, Marcelo Orvieto MD, Alberto Bustamante MD, Conrado Stein MD & Mario I. Fernández MD

  2. Faculty of Medicine, Clínica Alemana-Universidad del Desarrollo, Santiago, Chile

    Hugo Otaola-Arca MD, PhD, Alfred Krebs MD, Hugo Bermúdez MD, Raúl Lyng MD, Marcelo Orvieto MD, Alberto Bustamante MD, Conrado Stein MD, Andrés Labra MD, Marcela Schultz MD & Mario I. Fernández MD

  3. Department of Radiology, Clínica Alemana de Santiago, Santiago, Chile

    Andrés Labra MD

  4. Department of Pathology, Clínica Alemana de Santiago, Santiago, Chile

    Marcela Schultz MD

Authors
  1. Hugo Otaola-Arca MD, PhD
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Contributions

Study concept and design: HO-A and MIF. Acquisition of data: HO-A, AK, and MIF. Analysis and interpretation of data: HO-A, AL, MIF, AK, and MS. Drafting of the manuscript: HO-A, AK, and MIF. Critical revision of the manuscript for important intellectual content: HO-A, MIF, AK, MO, CS, HB, AB, RL, and MS. Statistical analysis: HO-A. Obtaining funding: None. Administrative, technical, or material support: MIF and AB. Supervision: None.

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Correspondence to Mario I. Fernández MD.

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Otaola-Arca, H., Krebs, A., Bermúdez, H. et al. Long-Term Oncological and Functional Outcomes After Robot-Assisted Partial Nephrectomy for Clinically Localized Renal Cell Carcinoma. Ann Surg Oncol 29, 2484–2494 (2022). https://doi.org/10.1245/s10434-021-11133-4

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