Role Of Robot-Assisted Partial Nephrectomy For Renal Cell Carcinomas In The Purpose Of Nephron Sparing

Figures & data

Figure 1 Illustration of actual tumor volume, excisional volume, and resection ratio.

Figure 2 Photograph of specimen to illustrate the measurement of length.

Table 1 Patients’ General Characteristics

Variables		Mean	SD	Range/Percentage
Total Number		136
Gender	Male	95		69.9%
	Female	41		30.1%
Age		57.8	12.4	25–80	Year-old
PADUA		8.38	1.52	6–12
RENAL		6.93	1.67	4–10
Side	Right	67		49.3%
	Left	69		50.7%
Stage	T1a	106		77.9%
	T1b	26		19.1%
	T2a	2		1.5%
	>T2a	2		1.5%
DM	Yes	40		29.4%
	No	96		70.6%
HTN	Yes	69		50.7%
	No	67		49.3%
Preoperative Cr		0.93	0.34	0.48–3.0	mg/dL
Preoperative GFR		85.4	26.0	20.3–183.1	mL/min/1.73m2
Surgery related Characteristics
Surgical Method	Open	71		52.20%
	Robotic-assisted	65		47.80%
Operation Time		261.7	85.0	117–664	mins
Blood Loss		193.6	344.7	5–2700	mL
Ischemic Time		39.1	15.7	12–87	mins
Complication	Yes	7		5.1%
	No	129		94.9%
Hospital Stay		8.01	4.4	4–46	days
Excisional Volume		34.4	43.2	2.4–314.2	mL
Actual Tumor Volume		18.6	34.2	0.2–293.2	mL
Tumor-to-Excision Ratio		45.5	21.5	3–95	%
Pathology	Clear cell	103		75.7%
	Chromophobe	20		14.7%
	Papillary	10		7.4%
	Others	3		2.2%
Positive Surgical Margin	Yes	7		5.1%
	No	129		94.9%
Recurrence	Yes	6		4.4%
	No	130		95.6%

Abbreviations: DM, diabetes mellitus; HTN, hypertension; GFR, glomerular filtration rate; Cr, creatinine.

Table 2 Comparison Of Patients Receiving Robotic-Assisted Or Open Partial Nephrectomy

Variables		Open PN			Robotic-Assisted PN
Number		71			65
								p value
Gender	Male	53			42			0.203
	Female	18			23
Age		60.1	12.6	Year-old	56.0	12.1	Year-old	0.042*
Stage	T1a	57			49			0.920
	T1b	12			14
	T2a	1			1
	T3a	1			1
PADUA score		8.48	1.44		8.28	1.60		0.442
RENAL score		7.00	1.62		6.86	1.74		0.632
Operation Time		224.3	55.4	Mins	302.5	93.0	Mins	0.000**
Blood Loss		141.7	163.3	mL	250.3	463.9	mL	0.077
Blood transfusion	Yes	5			5			0.885
	No	66			60
Ischemic Time		46.9	15.4	Mins	33.4	13.5	Mins	0.000**
Hospital Stay		8.75	5.6	Days	7.20	2.1	Days	0.034*
Complication	Yes	3			4			0.611
	No	68			61
Recurrence	Yes	3			3			0.912
	No	68			62
Positive Surgical Margin	Yes	2			5			0.199
	No	69			60
Excisional Volume		37.7	45.1	mL	30.9	41.1	mL	0.360
Actual Tumor Volume		18.8	36.4	mL	18.3	31.9	mL	0.943
Tumor-to-Excision Ratio		39.8	18.3	%	51.7	23.1	%	0.001**
Excisional Volume Loss		19.6	17.5	mL	12.7	14.5	mL	0.013*

Notes: *Correlation is significant at the 0.05 level (2-tailed); **Correlation is significant at the 0.01 level (2-tailed).

Table 3 Factors Correlated To Tumor-To-Excision Ratio

Variables		Pearson Correlation		Univariate p Value	Multi-Variate p Value
Age		−0.082		0.345
Robotic-assisted		0.276	**	0.001	0.002
PADUA		0.184	*	0.033	0.213
RENAL		0.160		0.064	0.512
Preoperative GFR	mL/min/1.73m2	0.175	*	0.043	0.221
Actual Tumor Volume	mL	0.426	**	<0.001	<0.001
Positive surgical margin		0.132		0.127	–

Notes: *Correlation is significant at the 0.05 level (2-tailed); **Correlation is significant at the 0.01 level (2-tailed).

Table 4 Predictors For GFR-P

		POM3				POM12
		Pearson Correlation		Univariate p Value	Multi-Variate p Value	Pearson Correlation		Univariate p Value	Multi-Variate p Value
Age		−0.042		0.627		0.040		0.647
Robotic-assisted		0.183	*	0.033	0.008	0.023		0.787	0.589
PADUA		−0.192	*	0.025	0.812	−0.300	**	0.000	0.077
RENAL		−0.217	*	0.011	0.224	−0.252	**	0.003	0.600
Tumor-to-excision Ratio		0.105		0.385		−0.060		0.488
Operation Time	mins	0.143		0.097		−0.030		0.725
Blood Loss	mL	−0.072		0.406		−0.077		0.373
Ischemia Time	mins	−0.036		0.727		−0.053		0.605
Preoperative GFR	mL/min/1.73m2	−0.207	*	0.016	0.000	−0.259	**	0.002	0.000
Excisional Volume	mL	−0.125		0.148	–	−0.218		0.011	–
Actual Tumor Volume	mL	−0.074		0.394	0.874	−0.147		0.088	0.787
Excisional Volume Loss	mL	−0.190	*	0.027	0.219	−0.275	**	0.001	0.037

Notes: *Correlation is significant at the 0.05 level (2-tailed); **Correlation is significant at the 0.01 level (2-tailed).

Figure 3 (A-B) The trend of GFR and GFR-P before and after partial nephrectomy in all patients. (C-D) The trend of GFR and GFR-P in patients with an EVL of ≥16 mL or <16 mL.