TY - JOUR
T1 - Transperitoneal vs retroperitoneal minimally invasive partial nephrectomy: comparison of perioperative outcomes and functional follow-up in a large multi-institutional cohort (The RECORD 2 Project)
AU - Simonato, Alchiede
AU - Polara, Andrea
AU - Grosso, Gaetano
AU - Ferro, Matteo
AU - Schiavina, Riccardo
AU - Capitanio, Umberto
AU - Berardinelli, Francesco
AU - Larcher, Alessandro
AU - Simeone, Claudio
AU - Volpe, Alessandro
AU - Antonelli, Alessandro
AU - Amparore, Daniele
AU - Falsaperla, Mario
AU - Furlan, Maria
AU - Longo, Nicola
AU - Terrone, Carlo
AU - Marra, Giancarlo
AU - Diminutto, Alberto
AU - Porreca, Angelo
AU - Rizzetto, Riccardo
AU - Di Maida, Fabrizio
AU - Costantini, Elisabetta
AU - Tellini, Riccardo
AU - Rocco, Bernardo
AU - Mari, Andrea
AU - Celia, Antonio
AU - Brunocilla, Eugenio
AU - Minervini, Andrea
AU - Schips, Luigi
AU - Roscigno, Marco
AU - Li Marzi, Vincenzo
AU - Altieri, Vincenzo
AU - Gontero, Paolo
AU - Bove, Pierluigi
AU - Da Pozzo, Luigi
AU - Simonato, Alchiede
AU - Villari, Donata
AU - Serni, Sergio
AU - Porpiglia, Francesco
AU - Vespasiani, Giuseppe
AU - Trombetta, Carlo
AU - Siracusano, Salvatore
AU - Ficarra, Vincenzo
AU - Fiori, Cristian
AU - Artibani, Walter
AU - Selli, Cesare
AU - Montorsi, Francesco
AU - Carini, Marco
PY - 2020
Y1 - 2020
N2 - Background: Aim of this study was to evaluate and compare perioperative outcomes of transperitoneal (TP) and retroperitoneal (TR) approaches in a multi-institutional cohort of minimally invasive partial nephrectomy (MI-PN). Material and methods: All consecutive patients undergone MI-PN for clinical T1 renal tumors at 26 Italian centers (RECORd2 project) between 01/2013 and 12/2016 were evaluated, collecting the pre-, intra-, and postoperative data. The patients were then stratified according to the surgical approach, TP or RP. A 1:1 propensity score (PS) matching was performed to obtain homogeneous cohorts, considering the age, gender, baseline eGFR, surgical indication, clinical diameter, and PADUA score. Results: 1669 patients treated with MI-PN were included in the study, 1256 and 413 undergoing TP and RP, respectively. After 1:1 PS matching according to the surgical access, 413 patients were selected from TP group to be compared with the 413 RP patients. Concerning intraoperative variables, no differences were found between the two groups in terms of surgical approach (lap/robot), extirpative technique (enucleation vs standard PN), hilar clamping, and ischemia time. Conversely, the TP group recorded a shorter median operative time in comparison with the RP group (115 vs 150 min), with a higher occurrence of intraoperative overall, 21 (5.0%) vs 9 (2.1%); p = 0.03, and surgical complications, 18 (4.3%) vs 7 (1.7%); p = 0.04. Concerning postoperative variables, the two groups resulted comparable in terms of complications, positive surgical margins and renal function, even if the RP group recorded a shorter median drainage duration and hospital length of stay (3 vs 2 for both variables), p < 0.0001. Conclusions: The results of this study suggest that both TP and RP are feasible approaches when performing MI-PN, irrespectively from tumor location or surgical complexity. Notwithstanding longer operative times, RP seems to have a slighter intraoperative complication rate with earlier postoperative recovery when compared with TP.
AB - Background: Aim of this study was to evaluate and compare perioperative outcomes of transperitoneal (TP) and retroperitoneal (TR) approaches in a multi-institutional cohort of minimally invasive partial nephrectomy (MI-PN). Material and methods: All consecutive patients undergone MI-PN for clinical T1 renal tumors at 26 Italian centers (RECORd2 project) between 01/2013 and 12/2016 were evaluated, collecting the pre-, intra-, and postoperative data. The patients were then stratified according to the surgical approach, TP or RP. A 1:1 propensity score (PS) matching was performed to obtain homogeneous cohorts, considering the age, gender, baseline eGFR, surgical indication, clinical diameter, and PADUA score. Results: 1669 patients treated with MI-PN were included in the study, 1256 and 413 undergoing TP and RP, respectively. After 1:1 PS matching according to the surgical access, 413 patients were selected from TP group to be compared with the 413 RP patients. Concerning intraoperative variables, no differences were found between the two groups in terms of surgical approach (lap/robot), extirpative technique (enucleation vs standard PN), hilar clamping, and ischemia time. Conversely, the TP group recorded a shorter median operative time in comparison with the RP group (115 vs 150 min), with a higher occurrence of intraoperative overall, 21 (5.0%) vs 9 (2.1%); p = 0.03, and surgical complications, 18 (4.3%) vs 7 (1.7%); p = 0.04. Concerning postoperative variables, the two groups resulted comparable in terms of complications, positive surgical margins and renal function, even if the RP group recorded a shorter median drainage duration and hospital length of stay (3 vs 2 for both variables), p < 0.0001. Conclusions: The results of this study suggest that both TP and RP are feasible approaches when performing MI-PN, irrespectively from tumor location or surgical complexity. Notwithstanding longer operative times, RP seems to have a slighter intraoperative complication rate with earlier postoperative recovery when compared with TP.
UR - http://hdl.handle.net/10447/431544
M3 - Article
JO - Surgical Endoscopy and Other Interventional Techniques
JF - Surgical Endoscopy and Other Interventional Techniques
SN - 0930-2794
ER -