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Redo Robotic Partial Nephrectomy for Recurrent Renal Tumors: A Multi-Institutional Analysis.

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INTRODUCTION As the experience with robot assisted partial nephrectomy (RAPN) grows, the indications have expanded to incorporate previously operated ipsilateral kidneys with recurrent renal masses. We sought to analyze the… Click to show full abstract

INTRODUCTION As the experience with robot assisted partial nephrectomy (RAPN) grows, the indications have expanded to incorporate previously operated ipsilateral kidneys with recurrent renal masses. We sought to analyze the outcomes of redo RAPN in patients with a recurrent renal mass. METHODS Using a multi-institutional series, the data of 72 patients who underwent RAPN for a recurrent renal mass between 2010 and 2020 were retrospectively analyzed. Patients with familial renal cell carcinoma and multiple renal tumors were excluded. Major complication defined by Clavien grade ≥3. The median follow-up was 28.5 months. Baseline demographics, clinical and tumor characteristics, perioperative and postoperative outcomes are reported. RESULTS Our cohort consisted of a combination of previous thermal ablation (19.6%), laparoscopic (19.6%), open (26.1%), and robotic (34.8%) partial nephrectomy. The median RENAL score was 8. Twenty percent had hilar tumors and 9.7% had a solitary kidney. RAPN was completed in all cases. Two cases (2.8%) were converted to open surgery. None of the cases were converted to radical nephrectomy intraoperatively. One patient underwent radical nephrectomy postoperatively due to bleeding. Transfusion rate was 5.9% and major complication rate was 8.3%. Median length of stay was 3 days. eGFR preservation was 78.7% at discharge and 90.8% at one-year follow-up. Positive surgical margin rate was 8.3%. Overall, distant recurrence was seen in 11 patients (15.3%), however, only one patient had local progression (1.4%). CONCLUSION In experienced hands, RAPN is an effective approach to treat select cases of locally recurrent renal masses with promising perioperative and functional outcomes. Patients should be carefully monitored for distant recurrence.

Keywords: recurrent renal; multi institutional; renal tumors; partial nephrectomy; redo robotic; robotic partial

Journal Title: Journal of endourology
Year Published: 2022

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