Skip to main content
SpringerLink
Log in

A multi-institutional analysis of 263 hilar tumors during robot-assisted partial nephrectomy

  • Original Article
  • Published:
Journal of Robotic Surgery Aims and scope Submit manuscript

Abstract

Hilar tumors pose unique challenges during partial nephrectomy. We present the characteristics and outcomes of 263 patients with hilar tumors undergoing robot-assisted partial nephrectomy (RPN) in the largest series to date. Perioperative, pathologic, functional, and oncological outcomes were compared between 1467 (84.8%) patients with a non-hilar tumor and 263 (15.2%) patients with a hilar tumor undergoing RPN. Variables were compared in univariable (unadjusted) analysis and using multivariable linear, logistic, poisson, cox proportional hazards and linear mixed effects regression models adjusting for tumor diameter and RENAL Nephrometry score. Hilar tumors were larger (3.7 vs. 3.0 cm, p < 0.001) and more complex (RENAL Score 9 vs. 7, p < 0.001), leading to longer operative time (186 vs. 161 min, p < 0.001), ischemia time (18 vs. 15, p < 0.001), greater blood loss (150 vs. 100 ml, p < 0.001), eGFR decline at discharge (∆ = 3.9%, p = 0.035) and eGFR decline per month up to 36 months post-RPN (β = − 0.25; p = 0.017). In multivariable analysis, hilar tumors were only associated with a 10% increase in operative time (p ≤ 0.001) and marginally worse eGFR decline over time (β = − 0.19, p = 0.076), with no differences in other outcomes analyzed including ischemia time, blood loss, complication rate, recurrence-free survival, or eGFR decline at discharge. Although hilar tumors were found to be larger and more anatomically complex, there were only marginal differences in outcome when compared to non-hilar tumors. A hilar renal tumor should be considered for partial nephrectomy when feasible without an expected increase in complications or adverse events.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Hafez KS, Fergany AF, Novick AC (1999) Nephron sparing surgery for localized renal cell carcinoma: impact of tumor size on patient survival, tumor recurrence and TNM staging. J Urol 162:1930–1933

    Article  CAS  Google Scholar 

  2. Novick AC, Gephardt G, Guz B, Steinmuller D, Tubbs RR (1991) Long-term follow-up after partial removal of a solitary kidney. N Engl J Med 325:1058–1062

    Article  CAS  Google Scholar 

  3. Ljungberg B, Bensalah K, Canfield S et al (2015) EAU guidelines on renal cell carcinoma: 2014 update. Eur Urol 67:913–924

    Article  Google Scholar 

  4. Campbell S, Uzzo RG, Allaf ME, et al. Renal mass and localized renal cancer: AUA guideline. http://www.auanet.org/guidelines/renal-mass-and-localized-renal-cancer-new-(2017). Accessed Jan 2019

  5. Patel HD, Mullins JK, Pierorazio PM et al (2013) Trends in renal surgery: robotic technology is associated with increased use of partial nephrectomy. J Urol 189:1229–1235. https://doi.org/10.1016/j.juro.2012.10.0248

    Article  PubMed  Google Scholar 

  6. Ghani KR, Sukumar S, Sammon JD, Rogers CG, Trinh QD, Menon M (2014) Practice patterns and outcomes of open and minimally invasive partial nephrectomy since the introduction of robotic partial nephrectomy: results from the nationwide inpatient sample. J Urol 191:907–912

    Article  Google Scholar 

  7. Shen Z, Xie L, Xie W et al (2016) The comparison of perioperative outcomes of robot-assisted and open partial nephrectomy: a systematic review and meta-analysis. World J Surg Oncol. 14(1):220

    Article  Google Scholar 

  8. Wu Z, Li M, Liu B et al (2014) Robotic versus open partial nephrectomy: a systematic review and meta-analysis. PLoS One 9(4):e94878

    Article  Google Scholar 

  9. Kutikov A, Uzzo RG et al (2009) The RENAL nephrometry score: a comprehensive standardized system for quantitating renal tumor size, location and depth. J Urol 182:844–853

    Article  Google Scholar 

  10. Kim SP, Campbell SC, Gill I et al (2017) Collaborative review of risk benefit trade-offs between partial and radical nephrectomy in the management of anatomically complex renal masses. Eur Urol 72:64–75

    Article  Google Scholar 

  11. Simhan J, Smaldone MC, Tsai KJ et al (2011) Objective measures of renal mass anatomic complexity predict rates of major complications following partial nephrectomy. Eur Urol 60:724–730

    Article  Google Scholar 

  12. Gill IS, Colombo JR, Frank I et al (2005) Laparoscopic partial nephrectomy for hilar tumors. J Urol 174:850–853

    Article  Google Scholar 

  13. Reisiger K, Venkatesh R, Figenshau RS et al (2005) Complex laparoscopic partial nephrectomy for renal hilar tumors. Urology 65:888–891

    Article  Google Scholar 

  14. Dulabon LM, Kaouk JH, Haber GP et al (2011) Multi-institutional analysis of robotic partial nephrectomy for Hilar versus nonhilar lesions in 446 consecutive cases. Eur Urol 59:325–330

    Article  Google Scholar 

  15. Harris PA, Taylor R, Thielke R et al (2009) Research electronic data capture (REDCap)—a metadata-driven methodology and workflow process for providing translational research informatics support. J Biomed Inf 42(2):377–381

    Article  Google Scholar 

  16. Schachter LR, Bach AM, Snyder ME et al (2006) The impact of tumour location on the histological subtype of renal cortical tumours. BJU Int 98:63–66

    Article  Google Scholar 

  17. Volpe A, Blute ML, Ficarra V et al (2015) Renal ischemia and function after partial nephrectomy: a collaborative review of the literature. Eur Urol 68:61–74

    Article  Google Scholar 

  18. Abreu AL, Gill IS, Desai MM (2011) Zero-ischaemia robotic partial nephrectomy (RPN) for hilar tumours. BJU Int 108:948–954

    Article  Google Scholar 

  19. Huang WC, Levey AS, Serio AM et al (2006) Chronic kidney disease after nephrectomy in patients with renal cortical tumours: a retrospective cohort study. Lancet Oncol 7:735–740

    Article  Google Scholar 

  20. Bruner B, Breau RH, Lohse CM et al (2011) Renal nephrometry score is associated with urine leak after partial nephrectomy. BJU Int 108:67–72

    Article  Google Scholar 

  21. Sagalovich D, Dagenais J, Bertolo R et al (2018) Trifecta outcomes in renal hilar tumors: a comparison between robotic and open partial nephrectomy. J Endourol 32(9):831–836

    Article  Google Scholar 

  22. Bauza Quetglas JL, Sagalovich D, Bertolo R et al (2018) Robotic partial nephrectomy for complex Hilar tumors: step by step. Urology 120:271–272

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Urology, Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Place, Box 1272, New York, NY, 10029-5674, USA

    Peter L. Sunaryo, David J. Paulucci, Kennedy Okhawere, Alp Tuna Beksac, John P. Sfakianos & Ketan K. Badani

  2. Department of Robotic Urologic Surgery, Ohio Health Dublin Methodist Hospital, Columbus, OH, USA

    Ronney Abaza

  3. Department of Urology, Temple University School of Medicine, Philadelphia, PA, USA

    Daniel D. Eun

  4. Division of Urology, Columbia University at Mount Sinai, Miami Beach, FL, USA

    Akshay Bhandari

  5. Department of Urology, Wake Forest School of Medicine, Winston-Salem, NC, USA

    Ashok K. Hemal

  6. Swedish Medical Center, Seattle, WA, USA

    James Porter

Authors
  1. Peter L. Sunaryo
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. David J. Paulucci
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Kennedy Okhawere
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Alp Tuna Beksac
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. John P. Sfakianos
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Ronney Abaza
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Daniel D. Eun
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Akshay Bhandari
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Ashok K. Hemal
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. James Porter
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Ketan K. Badani
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

Daniel D. Eun is a speaker, consultant on meetings and teaching activities for Intuitive, a consultant for Johnson and Johnson, a founder and part owner of Melzi corp, and a consultant for HAl. James Porter is a speaker and trainer for Intuitive, is on the advisory board for Ceevra and CSATs. Ronney Abaza is a speaker for Intuitive surgical, has a research grant with Conmed, and is a consultant for VTI.

Corresponding author

Correspondence to Peter L. Sunaryo.

Ethics declarations

Conflict of interest

Peter L Sunaryo, David J. Paulucci, Kennedy Okhawere, Alp Tuna Beksac, John P Sfakianos, Akshay Bhandari, Ashok K. Hemal, and Ketan K. Badani declare that they have no conflicts of interest or disclosures to list.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Sunaryo, P.L., Paulucci, D.J., Okhawere, K. et al. A multi-institutional analysis of 263 hilar tumors during robot-assisted partial nephrectomy. J Robotic Surg 14, 585–591 (2020). https://doi.org/10.1007/s11701-019-01028-8

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11701-019-01028-8

Keywords

Search

Navigation