Redo Partial Nephrectomy for Local Recurrence After Previous Nephron-sparing Surgery. Surgical Insights and Oncologic Results from a High-volume Robotic Center
Background: The role of redo partial nephrectomy (PN) for recurrent renal cell carcinoma (RCC) is still overlooked. Objective: To report our experience of salvage PN for local recurrence after previous nephron-sparing surgery (NSS). Design, setting, and participants: We prospectively gathered data f...
| Main Authors: | , , , , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Elsevier
2023-11-01
|
| Series: | European Urology Open Science |
| Subjects: | |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S266616832301087X |
| _version_ | 1797643570638749696 |
|---|---|
| author | Fabrizio Di Maida Antonio Andrea Grosso Riccardo Campi Luca Lambertini Maria Lucia Gallo Anna Cadenar Vincenzo Salamone Simone Coco Daniele Paganelli Agostino Tuccio Lorenzo Masieri Andrea Minervini |
| author_facet | Fabrizio Di Maida Antonio Andrea Grosso Riccardo Campi Luca Lambertini Maria Lucia Gallo Anna Cadenar Vincenzo Salamone Simone Coco Daniele Paganelli Agostino Tuccio Lorenzo Masieri Andrea Minervini |
| author_sort | Fabrizio Di Maida |
| collection | DOAJ |
| description | Background: The role of redo partial nephrectomy (PN) for recurrent renal cell carcinoma (RCC) is still overlooked. Objective: To report our experience of salvage PN for local recurrence after previous nephron-sparing surgery (NSS). Design, setting, and participants: We prospectively gathered data from patients treated with robotic redo PN for locally recurrent RCC after previous NSS from January 2017 to January 2023. The type of surgical resection technique was assigned to the pathologic specimen according to the surface-intermediate-base (SIB) score. Surgical procedure: Redo PN was performed by using the Si Da Vinci robotic platform. Measurements: Operative time, warm ischemia time, and intra- and postoperative complications were recorded. The severity of postoperative complications and tumor stage were evaluated. Results and limitations: Overall, 26 patients entered the study. The median clinical diameter was 3.5 (interquartile range [IQR] 2.2–4.9) cm and the median Preoperative Aspects and Dimensions Used for an Anatomical (PADUA) score was 8 (IQR 7–9). In 14 (53.8%) cases, recurrence was at the level of previous tumor resection bed. The median operative time was 177 (IQR 148–200) min, and hilar clamping was performed in 14 (53.8%) cases with a median warm ischemia time of 16 (14.5–22) min. Pure enucleation (SIB score 0–1), hybrid enucleation (SIB score 2), and pure enucleoresection (SIB score 3) were recorded in 13 (50%), eight (30.8%), and five (19.2%) cases, respectively. The totality of recurrent RCC far from previous tumor resection bed received a SIB score of 0–1, while in 57.1% and 35.8% of recurrent RCC on previous tumor resection a hybrid enucleation and a pure enucleoresection were performed, respectively. At a median follow-up of 37 (IQR 16–45) mo, five (19%) patients experienced disease recurrence, being local and systemic in three (11.5%) and two (7.7%) patients, respectively. Conclusions: Our study highlights the feasibility and safety of redo PN for the treatment of locally recurrent RCCs after NSS, either on previous tumor resection bed or elsewhere in the kidney. Patient summary: Robotic redo partial nephrectomy is a challenging procedure. The surgeon needs to tailor the surgical strategy and tumor resection technique case by case, given the heterogeneity of clinical scenarios and the need to achieve maximal functional preservation while ensuring oncologic efficacy. |
| first_indexed | 2024-03-11T14:17:28Z |
| format | Article |
| id | doaj.art-a4f698241c594578b4927a22c10cfc73 |
| institution | Directory Open Access Journal |
| issn | 2666-1683 |
| language | English |
| last_indexed | 2024-03-11T14:17:28Z |
| publishDate | 2023-11-01 |
| publisher | Elsevier |
| record_format | Article |
| series | European Urology Open Science |
| spelling | doaj.art-a4f698241c594578b4927a22c10cfc732023-11-01T04:48:05ZengElsevierEuropean Urology Open Science2666-16832023-11-01578490Redo Partial Nephrectomy for Local Recurrence After Previous Nephron-sparing Surgery. Surgical Insights and Oncologic Results from a High-volume Robotic CenterFabrizio Di Maida0Antonio Andrea Grosso1Riccardo Campi2Luca Lambertini3Maria Lucia Gallo4Anna Cadenar5Vincenzo Salamone6Simone Coco7Daniele Paganelli8Agostino Tuccio9Lorenzo Masieri10Andrea Minervini11Unit of Oncologic Minimally Invasive Urology and Andrology, Department of Experimental and Clinical Medicine, Careggi Hospital, University of Florence, Florence, Italy; Corresponding author. Unit of Oncologic Minimally Invasive Urology and Andrology, Department of Experimental and Clinical Medicine, Careggi Hospital, University of Florence, Largo Brambilla 3, Florence 50134, Italy. Tel. +393334335984; Fax: +390557942000.Unit of Oncologic Minimally Invasive Urology and Andrology, Department of Experimental and Clinical Medicine, Careggi Hospital, University of Florence, Florence, ItalyUnit of Urological Robotic Surgery and Renal Transplantation, Department of Experimental and Clinical Medicine, Careggi Hospital, University of Florence, Florence, ItalyUnit of Oncologic Minimally Invasive Urology and Andrology, Department of Experimental and Clinical Medicine, Careggi Hospital, University of Florence, Florence, ItalyUnit of Urological Robotic Surgery and Renal Transplantation, Department of Experimental and Clinical Medicine, Careggi Hospital, University of Florence, Florence, ItalyUnit of Oncologic Minimally Invasive Urology and Andrology, Department of Experimental and Clinical Medicine, Careggi Hospital, University of Florence, Florence, ItalyUnit of Oncologic Minimally Invasive Urology and Andrology, Department of Experimental and Clinical Medicine, Careggi Hospital, University of Florence, Florence, ItalyUnit of Oncologic Minimally Invasive Urology and Andrology, Department of Experimental and Clinical Medicine, Careggi Hospital, University of Florence, Florence, ItalyUnit of Oncologic Minimally Invasive Urology and Andrology, Department of Experimental and Clinical Medicine, Careggi Hospital, University of Florence, Florence, ItalyUnit of Oncologic Minimally Invasive Urology and Andrology, Department of Experimental and Clinical Medicine, Careggi Hospital, University of Florence, Florence, ItalyUnit of Urological Robotic Surgery and Renal Transplantation, Department of Experimental and Clinical Medicine, Careggi Hospital, University of Florence, Florence, ItalyUnit of Oncologic Minimally Invasive Urology and Andrology, Department of Experimental and Clinical Medicine, Careggi Hospital, University of Florence, Florence, ItalyBackground: The role of redo partial nephrectomy (PN) for recurrent renal cell carcinoma (RCC) is still overlooked. Objective: To report our experience of salvage PN for local recurrence after previous nephron-sparing surgery (NSS). Design, setting, and participants: We prospectively gathered data from patients treated with robotic redo PN for locally recurrent RCC after previous NSS from January 2017 to January 2023. The type of surgical resection technique was assigned to the pathologic specimen according to the surface-intermediate-base (SIB) score. Surgical procedure: Redo PN was performed by using the Si Da Vinci robotic platform. Measurements: Operative time, warm ischemia time, and intra- and postoperative complications were recorded. The severity of postoperative complications and tumor stage were evaluated. Results and limitations: Overall, 26 patients entered the study. The median clinical diameter was 3.5 (interquartile range [IQR] 2.2–4.9) cm and the median Preoperative Aspects and Dimensions Used for an Anatomical (PADUA) score was 8 (IQR 7–9). In 14 (53.8%) cases, recurrence was at the level of previous tumor resection bed. The median operative time was 177 (IQR 148–200) min, and hilar clamping was performed in 14 (53.8%) cases with a median warm ischemia time of 16 (14.5–22) min. Pure enucleation (SIB score 0–1), hybrid enucleation (SIB score 2), and pure enucleoresection (SIB score 3) were recorded in 13 (50%), eight (30.8%), and five (19.2%) cases, respectively. The totality of recurrent RCC far from previous tumor resection bed received a SIB score of 0–1, while in 57.1% and 35.8% of recurrent RCC on previous tumor resection a hybrid enucleation and a pure enucleoresection were performed, respectively. At a median follow-up of 37 (IQR 16–45) mo, five (19%) patients experienced disease recurrence, being local and systemic in three (11.5%) and two (7.7%) patients, respectively. Conclusions: Our study highlights the feasibility and safety of redo PN for the treatment of locally recurrent RCCs after NSS, either on previous tumor resection bed or elsewhere in the kidney. Patient summary: Robotic redo partial nephrectomy is a challenging procedure. The surgeon needs to tailor the surgical strategy and tumor resection technique case by case, given the heterogeneity of clinical scenarios and the need to achieve maximal functional preservation while ensuring oncologic efficacy.http://www.sciencedirect.com/science/article/pii/S266616832301087XLocal recurrencePartial nephrectomyRedoRoboticSurface-intermediate-base score |
| spellingShingle | Fabrizio Di Maida Antonio Andrea Grosso Riccardo Campi Luca Lambertini Maria Lucia Gallo Anna Cadenar Vincenzo Salamone Simone Coco Daniele Paganelli Agostino Tuccio Lorenzo Masieri Andrea Minervini Redo Partial Nephrectomy for Local Recurrence After Previous Nephron-sparing Surgery. Surgical Insights and Oncologic Results from a High-volume Robotic Center European Urology Open Science Local recurrence Partial nephrectomy Redo Robotic Surface-intermediate-base score |
| title | Redo Partial Nephrectomy for Local Recurrence After Previous Nephron-sparing Surgery. Surgical Insights and Oncologic Results from a High-volume Robotic Center |
| title_full | Redo Partial Nephrectomy for Local Recurrence After Previous Nephron-sparing Surgery. Surgical Insights and Oncologic Results from a High-volume Robotic Center |
| title_fullStr | Redo Partial Nephrectomy for Local Recurrence After Previous Nephron-sparing Surgery. Surgical Insights and Oncologic Results from a High-volume Robotic Center |
| title_full_unstemmed | Redo Partial Nephrectomy for Local Recurrence After Previous Nephron-sparing Surgery. Surgical Insights and Oncologic Results from a High-volume Robotic Center |
| title_short | Redo Partial Nephrectomy for Local Recurrence After Previous Nephron-sparing Surgery. Surgical Insights and Oncologic Results from a High-volume Robotic Center |
| title_sort | redo partial nephrectomy for local recurrence after previous nephron sparing surgery surgical insights and oncologic results from a high volume robotic center |
| topic | Local recurrence Partial nephrectomy Redo Robotic Surface-intermediate-base score |
| url | http://www.sciencedirect.com/science/article/pii/S266616832301087X |
| work_keys_str_mv | AT fabriziodimaida redopartialnephrectomyforlocalrecurrenceafterpreviousnephronsparingsurgerysurgicalinsightsandoncologicresultsfromahighvolumeroboticcenter AT antonioandreagrosso redopartialnephrectomyforlocalrecurrenceafterpreviousnephronsparingsurgerysurgicalinsightsandoncologicresultsfromahighvolumeroboticcenter AT riccardocampi redopartialnephrectomyforlocalrecurrenceafterpreviousnephronsparingsurgerysurgicalinsightsandoncologicresultsfromahighvolumeroboticcenter AT lucalambertini redopartialnephrectomyforlocalrecurrenceafterpreviousnephronsparingsurgerysurgicalinsightsandoncologicresultsfromahighvolumeroboticcenter AT marialuciagallo redopartialnephrectomyforlocalrecurrenceafterpreviousnephronsparingsurgerysurgicalinsightsandoncologicresultsfromahighvolumeroboticcenter AT annacadenar redopartialnephrectomyforlocalrecurrenceafterpreviousnephronsparingsurgerysurgicalinsightsandoncologicresultsfromahighvolumeroboticcenter AT vincenzosalamone redopartialnephrectomyforlocalrecurrenceafterpreviousnephronsparingsurgerysurgicalinsightsandoncologicresultsfromahighvolumeroboticcenter AT simonecoco redopartialnephrectomyforlocalrecurrenceafterpreviousnephronsparingsurgerysurgicalinsightsandoncologicresultsfromahighvolumeroboticcenter AT danielepaganelli redopartialnephrectomyforlocalrecurrenceafterpreviousnephronsparingsurgerysurgicalinsightsandoncologicresultsfromahighvolumeroboticcenter AT agostinotuccio redopartialnephrectomyforlocalrecurrenceafterpreviousnephronsparingsurgerysurgicalinsightsandoncologicresultsfromahighvolumeroboticcenter AT lorenzomasieri redopartialnephrectomyforlocalrecurrenceafterpreviousnephronsparingsurgerysurgicalinsightsandoncologicresultsfromahighvolumeroboticcenter AT andreaminervini redopartialnephrectomyforlocalrecurrenceafterpreviousnephronsparingsurgerysurgicalinsightsandoncologicresultsfromahighvolumeroboticcenter |