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Asian Journal of Urology, 2023, 10(4): 390-406    doi: 10.1016/j.ajur.2023.06.001
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A systematic review of robot-assisted partial nephrectomy outcomes for advanced indications: Large tumors (cT2-T3), solitary kidney, completely endophytic, hilar, recurrent, and multiple renal tumors
Savio Domenico Pandolfoab,Clara Cerratoc,Zhenjie Wude,Antonio Francoaf,Francesco Del Giudiceg,Alessandro Sciarrag,Paolo Verzeh,Giuseppe Lucarellii,Ciro Imbimbob,Sisto Perdonà,Edward E. Cherulloa,Francesco Porpiglia,Ithaar H. Derweesh,Riccardo Autorinoa*()
aDepartment of Urology, Rush University Medical Center, Chicago, IL, USA
bDepartment of Neurosciences, Reproductive Sciences and Odontostomatology, “Federico II” University, Naples, Italy
cDepartment of Urology, University of Verona, Verona, Italy
dDepartment of Urology, Changhai Hospital, Naval Medical University, Shanghai, China
eEuropean Association of Urology (EAU) Young Academic Urologists (YAU) Renal Cancer Working Group, Arnhem, the Netherlands
fDepartment of Urology, Sant’ Andrea Hospital, La Sapienza University, Rome, Italy
gDepartment of Maternal-Infant and Urologic Sciences, La Sapienza University, Policlinico Umberto I Hospital, Rome, Italy
hDepartment of Medicine and Surgery, Scuola Medica Salernitana, University of Salerno, Fisciano, Italy
iDepartment of Emergency and Organ Transplantation-Urology, Andrology and Kidney Transplantation Unit, University of Bari, Bari, Italy
jDepartment Uro-Gynecology, IRCCS G. Pascale Foundation, Naples, Italy
kDepartment of Urology, San Luigi Gonzaga Hospital, University of Turin, Orbassano, Italy
lDepartment of Urology, University of California San Diego, La Jolla, CA, USA
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Abstract: 

Objective: Robot-assisted partial nephrectomy (RAPN) has become widely used for treatment of renal cell carcinoma and it is expanding in the field of complex renal masses. The aim of this systematic review was to analyze outcomes of RAPN for completely endophytic renal masses, large tumors (cT2-T3), renal cell carcinoma in solitary kidney, recurrent tumors, completely endophytic and hilar masses, and simultaneous and multiple tumors.

Methods: A comprehensive search in the PubMed, Scopus, Web of Science, and Cochrane Central Register of Controlled Trials databases was performed in December 2022 for English language papers. The primary endpoint was to evaluate the role of RAPN in the setting of each category of complex renal masses considered. The secondary endpoint was to evaluate the surgical and functional outcomes.

Results: After screening 1250 records, 43 full-text manuscripts were selected, comprising over 8500 patients. Twelve and thirteen studies reported data for endophytic and hilar renal masses, respectively. Five and three studies reported outcomes for cT2-T3 and solitary kidney patients, respectively. Four studies focused on redo-RAPN for recurrent tumors. Two studies investigated simultaneous bilateral renal masses and five reports focused on multiple tumor excision in ipsilateral kidney.

Conclusion: Over the past decade, evidence supporting the use of RAPN for the most challenging nephron-sparing surgery indications has continuously grown. Although limitations remain including study design and lack of detailed long-term functional and oncological outcomes, the adoption of RAPN for the included advanced indications is associated with favorable surgical outcomes with good preservation of renal function without compromising the oncological result. Certainly, a higher likelihood of complication might be expected when facing extremely challenging cases. However, none of these indications should be considered per se an exclusion criterion for performing RAPN. Ultimately, a risk-adapted approach should be employed.

Key words:  Robot-assisted partial nephrectomy    Complex renal mass    Solitary kidney    Larger tumors (cT2-T3)    Endophytic and hilar mass    Recurrent tumor    Simultaneous and multiple tumor
收稿日期:  2023-01-30      修回日期:  2023-04-18      接受日期:  2023-06-19      出版日期:  2023-10-20      发布日期:  2023-11-13      整期出版日期:  2023-10-20
引用本文:    
. [J]. Asian Journal of Urology, 2023, 10(4): 390-406.
Savio Domenico Pandolfo, Clara Cerrato, Zhenjie Wu, Antonio Franco, Francesco Del Giudice, Alessandro Sciarra, Paolo Verze, Giuseppe Lucarelli, Ciro Imbimbo, Sisto Perdonà, Edward E. Cherullo, Francesco Porpiglia, Ithaar H. Derweesh, Riccardo Autorino. A systematic review of robot-assisted partial nephrectomy outcomes for advanced indications: Large tumors (cT2-T3), solitary kidney, completely endophytic, hilar, recurrent, and multiple renal tumors. Asian Journal of Urology, 2023, 10(4): 390-406.
链接本文:  
http://www.ajurology.com/CN/10.1016/j.ajur.2023.06.001  或          http://www.ajurology.com/CN/Y2023/V10/I4/390
  
Study Design Procedure, n Size (CT scan), cm R.E.N.A.L. nephrometry score OT, min EBL, mL WIT, min PSM, n (%) Follow-up, month Latest eGFR change, % Major postop. complication, n (%) Tri/pentafecta achievement, n (%)
Autorino et al., 2014 [19] RSC ?RAPN, 389

-Exophytic, 179
-3.7a -6.4a -186.7a -287a -17.1a -4 (2.2) -14.5a -?6.5a -3 (1.7) -96 (53.6)

-Mesophytic, 145
-3.3a -7.6a -189.8a -244a -20.2a -5 (3.5) -15.7a -?11.7a -7 (4.8) -86 (59.3)

-Endophytic, 65
-2.6a -8.7a -175.8a -225.8a -21.7a -3 (4.6) -12.6a -?9.4a -1 (1.4) -39 (60)
Komninos et al., 2014 [24] RSC ?RAPN, 225

-Exophytic, 45
-2.5b -5b -143b -200b -21b -1 (2.1) -38b -?1b -2 (3) -37 (57.8)

-Mesophytic, 116
-3.4b -8b -175b -300b -24b -4 (4) -43b -?3b -0 (0) -57 (49.1)

-Endophytic, 64
-2.6b -9b -169b -275b -24b -5 (12.5) -48b -?4.5b -2 (4.4) -17 (37.8)
Curtiss et al., 2015 [23] RSC ?RAPN, 297

-Meso-exophytic, 267
-2.7b -6b -162b -100b -17b -5 (2.4) -NR -NR -9 (3.4) -NR

-Endophytic, 30
-2.3b -9b -165b -100b -17b -0 (0) -NR -NR -0 (0) -NR
Kara et al., 2016 [20] RSC ?RAPN, 87
?OPN, 56
-2.8b
-3.1b
-9b
-9b
-185a
-206a
-175a
-341a
-24a
-20.6a
-4 (5.4)
-4 (8.7)
-15.2a
-18a
-NR
-NR
-18 (20.7)
-20 (35.7)
-NR
-NR
Abdel Raheem et al., 2019 [17] RSC ?RAPN, 52
?OPN, 37
-2.8a
-2.5a
-8.9a
-8.3a
-170a
-161a
-300b
-200b
-24b
-27b
-5 (9.6)
-3 (8.1)
-59b
-53b
-?11b
-?8b
-2 (3.8)
-1 (2.7)
-NR
-NR
Harke et al., 2018 [21] RMC ?RAPN, 64
?OPN, 76
-2.6a
-2.5a
-NR
-NR
-169a
-140a
-NR
-NR
-13a
-18a
-NR
-NR
-NR
-NR
-NR
-NR
-7 (10.9)
-9 (11.8)
-48 (75)
-52 (68.4)
Sun et al., 2021 [18] RSC ?RAPN, 58

-IOUS, 38
-2.9a -NR -201.2a -144.7a -20.4a -3 (7.9) -NR -?6.4a -1 (2.6) -NR

-No IOUS, 20
-3.2a -NR -189.8a -257.5a -25.6a -3 (15) -NR -?9.9a -0 (0) -NR
Carbonara et al., 2021 [16] RMC ?RAPN, 970

-Exophytic, 510
-3.2b -4b -155.7b -130b -16b -18 (3.9) -32.3b -?5.5b -32.3 (25.4) -234 (68.8)

-Mesophytic, 313
-4.1b -8b -163.4b -185.5b -21b -11 (3.7) -27.8b -?9.6b -27.8 (43) -114 (50.9)

-Endophytic, 147
-2.4b -10b -178.5b -177b -22b -6 (4.5) -21.6b -?10.8b -21.6 (20) -44 (45.4)
Gu et al., 2020 [22] RSC ?RAPN, 61
?LPN, 51
-2.3b
-2.5b
-NR
-NR
-105b
-108b
-50b
-NR
-20b
-20b
-2 (3.3)
-1 (2)
-NR
-NR
-?9.8b
-?10.6b
-2 (3.2)
-0 (0)
-26 (42.6)
-19 (37.3)
Minoda et al., 2021 [15] RSC ?RAPN, 144
o-Enucleation, 72
o-Resection, 72
-2.6b -9b -151b
-140b
-167b
-78b
-86b
-NR
-NR
-23b
-21b
-4 (2.8)
-3 (6.7)
-1 (2.2)
-NR -?6.6b
-?4.9b
-?16b
-4 (2.8)
-3 (4.3)
-1 (1.4)
-NR
Motoyama et al., 2022 [14] RSC ?RAPN, 265

-Exophytic, 127
-2.9b -6b -178b -55b -13b -1 (0) -NR -NR -3 (2.4) -NR

-Mesophytic, 112
-2.3b -8b -168b -44b -13b -1 (0.9) -NR -NR -2 (1.8) -NR

-Endophytic, 26
-1.9b -9b -172b -51b -16b -0 (0) -NR -NR -2 (7.7) -NR
Okhawere et al., 2023 [25] RMC ?RAPN, 156

-Transperitoneal, 112
-2.6b -9b -160b -100b -19.5b -3 (2.7) -NR -6.1b -3 (2.7) -NR

-Retroperitoneal, 44
-2.4b -9b -157b -50b -19.6b -1 (2.3) -NR -5.3b -2 (4.6) -NR
  
Study Design Procedure, n Size (CT scan), cm R.E.N.A.L. nephrometry score OT, min EBL, mL WIT, min PSM, n Follow-up, month Latest eGFR change Major postop. complication, n Recurrence, n
Dulabon et al., 2011 [38] RMC ?RAPN, 446
-Hilar, 41 -3.46a -NR -194.5a -262.2a -26.3a -1 -NR -NR -0 -NR

-Nonhilar, 405
-2.88a -NR -187.4a -208.2a -19.6a -6 -NR -NR -7 -NR
Khalifeh et al., 2012 [37] RSC ?Novel, 5
?Standard, 10
-5.02b
-4.66b
-10b
-10b
-215.2b
-195b
-250b
-575b
-31.6b
-30.7b
-NR
-NR
-3b
-3b
-?11.4b
-?7.26b
-0
-2
-NR
-NR
Eyraud et al., 2013 [28] RSC ?RAPN, 364

-Hilar, 70
-3.9b -NR -210b -250b -27b -1 -7.4b -NR -NR -NR

-Nohilar, 294
-2.6b -NR -180b -200b -17b -9 -7.4b -NR -NR -NR
Miyake et al., 2015 [31] RSC ?RAPN, 16
?OPN, 15
-3.0a
-3.2a
-NR
-NR
-263.0a
-203.7a
-57.5a
-653.6a
-23.0a
-20.3a
-0
-0
-NR -?10.0a
-?10.4a
-NR -0
-0
Lu et al., 2018 [29] RSC ?RAPN, 200

-Hilar, 30
-4.8a -9a -293.6a -418.7a -39.9a -1 -28a -?4.6a -0 -NR

-Nonhilar, 70
-3.7a -7.4a -240.5a -205.8a -21.8a -0 -32.3a -?6.4a -4 -NR
Gao et al., 2020 [34] RSC ?RAPN, 286 -2.6a -8.2a -120b -100b -18.2b -3 -48b -NR -18 -3
Sunaryo et al., 2020 [27] RMC ?RAPN, 1730

-Hilar, 263
-3.7b -9b -186b -100a -18b -9 -NR -?16.8b -12 -NR

-Nonhilar, 1467
-3b -7b -161b -100a -15b -68 -NR -?12.6b -54 -NR
Mellouki et al., 2021 [30] ND ?RAPN, 1359

-Off-clamp, 224
-3.6a -7a -NR -198.9a -17.6a -12 -NR -NR -14 -6

-On-clamp, 1135
-3.8a -7a -NR -229.5a -NR -122 -NR -NR -65 -41
Tyagi et al., 2021 [26] RSC ?RAPN, 201

-Hilar, 48
-4.7a -7.9a -162.4a -201.8b -29.0a -3 -NR -NR -1 -NR

-Nonhilar, 153
-3.7a -7.8a -144.1a -150.6b -24.4a -1 -NR -NR -0 -NR
Hinata et al., 2021 [33] PMC ?RAPN, 105 -3.2a -8.7a -146a -138a -20.2a -NR -24a -?9.6a -NR -NR
Chen et al., 2020 [32] RSC ?RAPN, 52
?LPN, 64
-4.3a
-4.1a
-NR
-NR
-130a
-126.6a
-100a
-150a
-20.3a
-24.5a
-0
-0
-6a
-6a
-?9.2a
-?13.0a
-1
-2
-NR
-NR
Ferriero et al., 2022 [36] ND ?RAPN, 20

-Off-clamp, 20
-3.0b -10b -85b -150b -NR -0 -27b -NR -0 -1
Zhang et al., 2022 [35] RSC ?RAPN, 8 -4.2a -9.5b -144a -86a -27.9a -0 -NR -NR -0 -NR
  
Study Design Tumor stage Procedure, n Size (CT scan), cm R.E.N.A.L. nephrometry score OT, min EBL, mL WIT, min PSM, n Follow-up, month Major postop. complication, n Recurrence, n Metastasis, n
Bertolo et al., 2018 [39] RMC ≥cT2 ?RAPN, 298 -7.6a -9a -150a -150a -25a -20 -12a -15 -25 -NR
Long et al., 2020 [40] RSC ≥cT2 ?RAPN, 16
?LPN, 7
?RN, 30
-8.1a
-8a
-NR
-10-12: 68.8%
-10-12: 71.4%
-10-12: 83.3%
-130a
-140a
-90a
-100a
-150a
-25a
-20a
-25.5a
-NR
-0
-0
-0
-31.5a
-44a
-37a
-0
-0
-0
-0
-0
-0
-1
-0
-0
Yim et al., 2021 [43] RMC ≥cT3a ?RAPN, 157 -7a - 10-12: 33.1% -190b -242b -19b -NR -7a -7 -2 -17
Morgan et al., 2022 [42] RSC ≥pT3 with RVT ?RAPN, 45 -4.3b -8.3b -199.6b -324.9b -30.5b -3 -28.5a -7 -2 -4
Beksac et al., 2022 [41] RMC ≥cT2 single kidney ?RAPN, 20
?OPN, 15
-5.8a
-6a
-9a
-10a
-258a
-232a
-325a
-300a
-27.3b
-28.9b
-3
-3
-21b
-21b
-2
-5
-2
-1
-NR
-NR
  
Study Design Procedure, n Sizea (CT scan), cm R.E.N.A.L. nephrometry score OT, min EBLa, mL WIT, min PSM, n Temporary dialysis, n Follow-up, month Latest eGFR change (%)b Major postop. complication, n
Hillyer et al., 2013 [45] RMC ?RAPN, 26 - 4.3 - 6a - 210a - 225 - 17a - 1 - 0 - 6a - NR - 3
Zargar et al., 2014 [44] RMC ?Simple tumorc

-RAPN, 30
-2.5 -6b -174.9b -200 -15a -2 -0 -7.8a -NR -6

-OPN, 33
-3.5 -7b -185.4b -300 -23a -3 -2 -14a -NR -6
?Complex tumord

-RAPN, 10
-4.15 -9.5b -250.8b -225 -22.7a -1 -2 -4a -NR -1

-OPN, 53
-4.3 -10b -244.1b -300 -23.9a -4 -3 -19.6a -NR -7
Beksac et al., 2022 [41] RMC ?≥cT2 single kidney

-RAPN, 20
-5.8 -9a -258a -325 -27.3b -3 -1 -21b -2 -2

-OPN, 15
-6 -10a -232a -300 -28.9b -3 -1 -21b -5 -1
  
Study Design Procedure, n Total tumor lesion, n Size (CT scan), cm R.E.N.A.L. nephrometry scorea OTa, min EBL, mL WIT, min PSM, n (%) Follow-upa, month Major postop. complication, n (%)
Autorino et al., 2013 [46] RSC ?Redo-RAPN, 9 -12 -2a -7a -153 -150b -17.5a -NR -8.3 -0
Martini et al., 2021 [47] RMC ?RAPN in MR, 2
?RARN in MR, 10
?RAPN in PTF, 6
?RARN in PTF, 14
-NR -3a
-3a
-3a
-4a
-NR -200
-124
-157
-155
-NR -NR -0
-2
-0
-1
-35 -0
-0
-0
-0
Beksac et al., 2022 [49] RMC ?Redo-RAPN, 72 -NR -3.7b -8b -NR -150b -22b -6 (8.3) -28.5 -6 (8.3)
Margue et al., 2022 [48] RSC ?Redo-RAPN, 11 -18 -3.4a -4-6: 5c
-7-9: 8c
-10-12: 5c
-318 -300a -NR -NR -NR -2 (18.2)
  
Study Design Procedure, n Sizea (CT scan), cm OTa, min EBLa, mL WITa, min PSM, n Follow-up, month Major postop. complication, n
Otoshi et al., 2021 [50] RSC ?RAPN, 8 -1.4 -334 (range 199-576) -90 (range 5-400) -13 (range 0-40) -0 -NR -1
Gallo et al., 2022 [51] RMC ?RAPN, 27 -2.5 -250 -200 -15 -NR -30a -1
  
Study Design Procedure, n Total tumor lesion, n Size (CT scan), cm Tumors for patients, n R.E.N.A.L. nephrometry score OTa, min EBLa, mL WITa, min Follow-up, month Conversion, n Major postop. complication, n
Boris et al., 2009 [54] RSC ?Multiple RAPN, 24 -24 -2.3a -2.7a -NR -257 -360 -29.6 -9.4a -1 -1
Hankins et al., 2016 [52] ND ?RAPN, 54 -121 NR -8.6a -NR -382 -1439 -NR -6a -7 -NR
Maurice et al., 2016 [53] RSC ?RAPN, 1221 -1237 -NR -NR -NR

-1 mass, 1172
-3.4a -7.4a -188 -231 -21 -20.7a

-2 tumors, 35
-2.7a -6.4a -194 -184 -16 -16a

-≥3 tumors, 14
-3.4a -7.4a -240 -330 -24 -19.8a
Yerram et al., 2018 [56] RSC ?OPN, 42
?RAPN, 68
-109
-163
-2.1b
-2.1b
-2.6a
-2.4a
-NR
-NR
-224
-221
-357
-280
-NR
-NR
-22.1b
-7.5b
-NR
-NR
-NR
-NR
Yang et al., 2019 [55] RSC ?RAPN, 12 -26 -2.7a -NR -NR -91.7 -150 -37.5 -5.4a -0 -0
  
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