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

doi:10.1016/j.ajur.2023.06.001

Asian Journal of Urology, 2023, 10 (4): 390-406 doi: 10.1016/j.ajur.2023.06.001

Review

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 Pandolfo^a,b,Clara Cerrato^c,Zhenjie Wu^d,e,Antonio Franco^a,f,Francesco Del Giudice^g,Alessandro Sciarra^g,Paolo Verze^h,Giuseppe Lucarelliⁱ,Ciro Imbimbo^b,Sisto Perdonà,Edward E. Cherullo^a,Francesco Porpiglia,Ithaar H. Derweesh,Riccardo Autorino^a,*(

)

^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

Received: 30 January 2023 Available online: 20 October 2023

Corresponding Authors: *E-mail address: ricautor@gmail.com (R. Autorino).

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	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

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Cite this article:

Savio Domenico Pandolfo,Clara Cerrato,Zhenjie Wu, et al. 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[J]. Asian Journal of Urology, 2023, 10(4): 390-406.

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http://www.ajurology.com/EN/10.1016/j.ajur.2023.06.001 OR http://www.ajurology.com/EN/Y2023/V10/I4/390

The flow diagram for identification of studies via databases and registers [112].

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	-3.7^a	-6.4^a	-186.7^a	-287^a	-17.1^a	-4 (2.2)	-14.5^a	-?6.5^a	-3 (1.7)	-96 (53.6)
		-Mesophytic, 145	-3.3^a	-7.6^a	-189.8^a	-244^a	-20.2^a	-5 (3.5)	-15.7^a	-?11.7^a	-7 (4.8)	-86 (59.3)
		-Endophytic, 65	-2.6^a	-8.7^a	-175.8^a	-225.8^a	-21.7^a	-3 (4.6)	-12.6^a	-?9.4^a	-1 (1.4)	-39 (60)
Komninos et al., 2014 [24]	RSC	?RAPN, 225
		-Exophytic, 45	-2.5^b	-5^b	-143^b	-200^b	-21^b	-1 (2.1)	-38^b	-?1^b	-2 (3)	-37 (57.8)
		-Mesophytic, 116	-3.4^b	-8^b	-175^b	-300^b	-24^b	-4 (4)	-43^b	-?3^b	-0 (0)	-57 (49.1)
		-Endophytic, 64	-2.6^b	-9^b	-169^b	-275^b	-24^b	-5 (12.5)	-48^b	-?4.5^b	-2 (4.4)	-17 (37.8)
Curtiss et al., 2015 [23]	RSC	?RAPN, 297
		-Meso-exophytic, 267	-2.7^b	-6^b	-162^b	-100^b	-17^b	-5 (2.4)	-NR	-NR	-9 (3.4)	-NR
		-Endophytic, 30	-2.3^b	-9^b	-165^b	-100^b	-17^b	-0 (0)	-NR	-NR	-0 (0)	-NR
Kara et al., 2016 [20]	RSC	?RAPN, 87 ?OPN, 56	-2.8^b -3.1^b	-9^b -9^b	-185^a -206^a	-175^a -341^a	-24^a -20.6^a	-4 (5.4) -4 (8.7)	-15.2^a -18^a	-NR -NR	-18 (20.7) -20 (35.7)	-NR -NR
Abdel Raheem et al., 2019 [17]	RSC	?RAPN, 52 ?OPN, 37	-2.8^a -2.5^a	-8.9^a -8.3^a	-170^a -161^a	-300^b -200^b	-24^b -27^b	-5 (9.6) -3 (8.1)	-59^b -53^b	-?11^b -?8^b	-2 (3.8) -1 (2.7)	-NR -NR
Harke et al., 2018 [21]	RMC	?RAPN, 64 ?OPN, 76	-2.6^a -2.5^a	-NR -NR	-169^a -140^a	-NR -NR	-13^a -18^a	-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	-2.9^a	-NR	-201.2^a	-144.7^a	-20.4^a	-3 (7.9)	-NR	-?6.4^a	-1 (2.6)	-NR
		-No IOUS, 20	-3.2^a	-NR	-189.8^a	-257.5^a	-25.6^a	-3 (15)	-NR	-?9.9^a	-0 (0)	-NR
Carbonara et al., 2021 [16]	RMC	?RAPN, 970
		-Exophytic, 510	-3.2^b	-4^b	-155.7^b	-130^b	-16^b	-18 (3.9)	-32.3^b	-?5.5^b	-32.3 (25.4)	-234 (68.8)
		-Mesophytic, 313	-4.1^b	-8^b	-163.4^b	-185.5^b	-21^b	-11 (3.7)	-27.8^b	-?9.6^b	-27.8 (43)	-114 (50.9)
		-Endophytic, 147	-2.4^b	-10^b	-178.5^b	-177^b	-22^b	-6 (4.5)	-21.6^b	-?10.8^b	-21.6 (20)	-44 (45.4)
Gu et al., 2020 [22]	RSC	?RAPN, 61 ?LPN, 51	-2.3^b -2.5^b	-NR -NR	-105^b -108^b	-50^b -NR	-20^b -20^b	-2 (3.3) -1 (2)	-NR -NR	-?9.8^b -?10.6^b	-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	-2.6^b	-9^b	-151^b -140^b -167^b	-78^b -86^b -NR	-NR -23^b -21^b	-4 (2.8) -3 (6.7) -1 (2.2)	-NR	-?6.6^b -?4.9^b -?16^b	-4 (2.8) -3 (4.3) -1 (1.4)	-NR
Motoyama et al., 2022 [14]	RSC	?RAPN, 265
		-Exophytic, 127	-2.9^b	-6^b	-178^b	-55^b	-13^b	-1 (0)	-NR	-NR	-3 (2.4)	-NR
		-Mesophytic, 112	-2.3^b	-8^b	-168^b	-44^b	-13^b	-1 (0.9)	-NR	-NR	-2 (1.8)	-NR
		-Endophytic, 26	-1.9^b	-9^b	-172^b	-51^b	-16^b	-0 (0)	-NR	-NR	-2 (7.7)	-NR
Okhawere et al., 2023 [25]	RMC	?RAPN, 156
		-Transperitoneal, 112	-2.6^b	-9^b	-160^b	-100^b	-19.5^b	-3 (2.7)	-NR	-6.1^b	-3 (2.7)	-NR
		-Retroperitoneal, 44	-2.4^b	-9^b	-157^b	-50^b	-19.6^b	-1 (2.3)	-NR	-5.3^b	-2 (4.6)	-NR

Outcomes of RAPN for endophytic renal masses: overview of reported series.

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	-3.46^a	-NR	-194.5^a	-262.2^a	-26.3^a	-1	-NR	-NR	-0	-NR
		-Nonhilar, 405	-2.88^a	-NR	-187.4^a	-208.2^a	-19.6^a	-6	-NR	-NR	-7	-NR
Khalifeh et al., 2012 [37]	RSC	?Novel, 5 ?Standard, 10	-5.02^b -4.66^b	-10^b -10^b	-215.2^b -195^b	-250^b -575^b	-31.6^b -30.7^b	-NR -NR	-3^b -3^b	-?11.4^b -?7.26^b	-0 -2	-NR -NR
Eyraud et al., 2013 [28]	RSC	?RAPN, 364
		-Hilar, 70	-3.9^b	-NR	-210^b	-250^b	-27^b	-1	-7.4^b	-NR	-NR	-NR
		-Nohilar, 294	-2.6^b	-NR	-180^b	-200^b	-17^b	-9	-7.4^b	-NR	-NR	-NR
Miyake et al., 2015 [31]	RSC	?RAPN, 16 ?OPN, 15	-3.0^a -3.2^a	-NR -NR	-263.0^a -203.7^a	-57.5^a -653.6^a	-23.0^a -20.3^a	-0 -0	-NR	-?10.0^a -?10.4^a	-NR	-0 -0
Lu et al., 2018 [29]	RSC	?RAPN, 200
		-Hilar, 30	-4.8^a	-9^a	-293.6^a	-418.7^a	-39.9^a	-1	-28^a	-?4.6^a	-0	-NR
		-Nonhilar, 70	-3.7^a	-7.4^a	-240.5^a	-205.8^a	-21.8^a	-0	-32.3^a	-?6.4^a	-4	-NR
Gao et al., 2020 [34]	RSC	?RAPN, 286	-2.6^a	-8.2^a	-120^b	-100^b	-18.2^b	-3	-48^b	-NR	-18	-3
Sunaryo et al., 2020 [27]	RMC	?RAPN, 1730
		-Hilar, 263	-3.7^b	-9^b	-186^b	-100^a	-18^b	-9	-NR	-?16.8^b	-12	-NR
		-Nonhilar, 1467	-3^b	-7^b	-161^b	-100^a	-15^b	-68	-NR	-?12.6^b	-54	-NR
Mellouki et al., 2021 [30]	ND	?RAPN, 1359
		-Off-clamp, 224	-3.6^a	-7^a	-NR	-198.9^a	-17.6^a	-12	-NR	-NR	-14	-6
		-On-clamp, 1135	-3.8^a	-7^a	-NR	-229.5^a	-NR	-122	-NR	-NR	-65	-41
Tyagi et al., 2021 [26]	RSC	?RAPN, 201
		-Hilar, 48	-4.7^a	-7.9^a	-162.4^a	-201.8^b	-29.0^a	-3	-NR	-NR	-1	-NR
		-Nonhilar, 153	-3.7^a	-7.8^a	-144.1^a	-150.6^b	-24.4^a	-1	-NR	-NR	-0	-NR
Hinata et al., 2021 [33]	PMC	?RAPN, 105	-3.2^a	-8.7^a	-146^a	-138^a	-20.2^a	-NR	-24^a	-?9.6^a	-NR	-NR
Chen et al., 2020 [32]	RSC	?RAPN, 52 ?LPN, 64	-4.3^a -4.1^a	-NR -NR	-130^a -126.6^a	-100^a -150^a	-20.3^a -24.5^a	-0 -0	-6^a -6^a	-?9.2^a -?13.0^a	-1 -2	-NR -NR
Ferriero et al., 2022 [36]	ND	?RAPN, 20
Ferriero et al., 2022 [36]	ND	-Off-clamp, 20	-3.0^b	-10^b	-85^b	-150^b	-NR	-0	-27^b	-NR	-0	-1
Zhang et al., 2022 [35]	RSC	?RAPN, 8	-4.2^a	-9.5^b	-144^a	-86^a	-27.9^a	-0	-NR	-NR	-0	-NR

Outcomes of RAPN for hilar renal masses: overview of reported series.

Outcomes of RAPN for larger tumors (cT2-T3): overview of reported series.

Outcomes of RAPN for solitary kidney: overview of reported series.

Outcomes of RAPN for recurrent localized renal tumor: overview of reported series.

Outcomes of RAPN for simultaneous bilateral tumors: overview of reported series.

Outcomes of RAPN for multiple ipsilateral tumors: overview of reported series.

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