PERIOPERATIVE OUTCOMES OF ROBOTIC VERSUS OPEN SIMPLE ENUCLEATION FOR THE TREATMENT OF T1A-T1B RENAL CELL CARCINOMA. A SINGLE CENTER MATCHED-PAIR COMPARISON.

Scopo del lavoro The Simple Enucleation (SE), is a technique of nephron sparing surgery who excides the tumor surrounded by no visible rim of healthy parenchyma, developing by blunt dissection the natural plane between tumor pseudocapsule and healthy parenchyma. No previous study evaluated surgical, pathological, and short-term functional perioperative outcomes of robotic approach to SE. Aim of this study is to compare surgical results, morbidity and pathological data, including positive surgical margin (PSM) rate, of endoscopic robotic- assisted simple enucleation (ERASE) with those of open simple enucleation (OSE). Materiali e metodi We undertook matched-pair analysis (age, tumor size and nephrometry) of 392 patients treated with OSE or ERASE for T1a-T1b renal tumors in our department, including 160 patients in OSE group and 80 in ERASE. Surgical, pathological, short-term functional data and complications of ERASE and OSE were compared with univariate analysis. Perioperative variables independently associated with warm ischemia time (WIT)>25 min, complications, and postoperative acute kidney dysfunction (AKD) were assessed with multivariate analysis, separately. Risultati The matched groups were comparable in age, tumor size, nephrometry BMI, comorbidity index, and preoperative renal function. No significant difference resulted in ERASE vs. OSE group regarding WIT (18.5 vs. 16.4 min; p=0.5), intraoperative complications, postoperative complications, transfusion rate, reoperation rate for Clavien grade≥3 complication, and PSM rate (2.9% vs. 2.1%; p=0.63). In patients with elective indication to nephron sparing surgery, no significant difference resulted in variation of estimated glomerular filtration rate from baseline (8.5 vs. 13.9 ml/min; p=0.17) and in the incidence of acute renal failure. In ERASE comparing with OSE group, the clamping of renal pedicle was used with a significantly lower frequency (60% vs. 93.8% of patients; P25 min, nor with postoperative acute renal failure. Discussione The robotic approach to simple enucleation is feasible, and not inferior to open regarding surgical, pathological, short-term functional outcomes and morbidity. The loss of tactile sensation did not increase the technical difficulty of procedure, nor the positive surgical margin rate, in our analysis. Conclusioni the ERASE showed comparable perioperative outcomes to OSE, with the added benefits of lower recourse to pedicle clamping, a one day shorter hospitalization, along with the clear advantages of mini-invasivity.