ORIGINAL ARTICLE   Free access

Minerva Urology and Nephrology 2022 April;74(2):209-15

DOI: 10.23736/S2724-6051.22.04693-6

Copyright © 2022 EDIZIONI MINERVA MEDICA

language: English

Feasibility of salvage robotic partial nephrectomy after ablative treatment failure (UroCCR-62 study)

Gaëlle MARGUE ¹ ✉, Clément MICHIELS ¹, Clément ALLENET ¹, Laure DUPITOUT ¹, Solène RICARD ², Eva JAMBON ³, Peggy BLANC ¹, Eric ALEZRA ¹, Vincent ESTRADE ¹, Grégoire CAPON ¹, Franck BLADOU ¹, Grégoire ROBERT ¹, Nicolas GRENIER ³, Jean-Christophe BERNHARD ¹

¹ Department of Urology, Bordeaux University Hospital, Bordeaux, France; ² French Research Network on Kidney Cancer (UroCCR), Bordeaux, France; ³ Department of Radiology, Bordeaux University Hospital, Bordeaux, France

BACKGROUND: Ablative therapies (AT) are increasingly being offered to patients with kidney tumors. In cases of failure or local relapse, salvage surgery may be required. Such procedures often require an open approach, are difficult and have received little attention in the literature. We aim to evaluate the feasibility of salvage robot-assisted partial nephrectomy (sRAPN) after AT.
METHODS: We conducted a monocentric retrospective study of all patients who benefited from sRAPN. Clinical data were collected prospectively after written consent in the French UroCCR database.
RESULTS: Between 2013 and 2020, 724 RAPN were performed in our center; of these, 11 patients underwent salvage RAPN and four (36.4%) had an imperative indication for a solitary kidney. The median patient age was 54 (49-72) years, median preoperative glomerular filtration rate (GFR) was 65.5 (42.9-88.4) mL/min/1.73 m², and median tumor diameter was 34 (16-38) mm. Extensive perinephric fibrosis was present in 90.9% of cases. Postoperative complications occurred in 36.4% of patients, including major complications in 18.2%. The median GFR at three months (56.8 [45.9-63.9] mL/min/1.73 m²) and at last follow-up (52.1 [45.85-68.3] mL/min/1.73 m²) were not significantly different to the preoperative GFR (P=0.51 and P=0.65, respectively). During follow-up (median 12 months), three patients (all with Von Hippel Lindau disease) developed a recurrence, but none were on the sRAPN site.
CONCLUSIONS: Our series of sRAPN following AT failure confirms that such surgery is feasible with good functional and oncological results. However, these surgeries remain difficult, are associated with significant complication rate and should be performed in expert centers.

KEY WORDS: Ablation techniques; Cryosurgery; Radiofrequency ablation; Kidney neoplasms; Nephrectomy