SIMPLE ENUCLEATION FOR THE TREATMENT OF HIGHLY COMPLEx RENAL TUMORS: PERIOPERATIVE, FUNCTIONAL AND ONCOLOGICAL RESULTS.

Aim of the study to assess perioperative, functional and oncological results of simple enucleation (SE) in patients with RCC with 10-13 PADUA score, and to evaluate differences in perioperative results between open and robotic SE. Materials and methods The data of 510 patients treated with SE between July 2006 and August 2013 in our department for RCC were gathered in a prospectively maintained database. Of these, 96 had RCC with PADUA 10-13 (high risk nephrometry tumors) and were selected for this study, including 76 treated open and 20 with robotic SE (endoscopic robotic-assisted simple enucleation: ERASE). Conventional perioperative variables were collected and compared between open and robotic approach with univariate analysis. Survival status and functional data were gathered at follow-up. The probability of survival was estimated by the Kaplan-Meier method. Results The mean tumor diameter was 4.8 cm, the PADUA score resulted 10, 11, 12 and 13 in 57.3%, 29.2%, 11.5%, and 2.1% of tumors, respectively. Overall, 19.8% of patients had stage≥3 chronic kidney disease (CKD) and the 17.7% an imperative/relative indication. Clamping of renal pedicle was used for almost all patients(99%), with a mean WIT of 19,2 ± 5,7 minutes. Average operative time was 126 minutes, mean EBL was about 200 cc, and median(IQR) LOS was 6(5-7) days. The percentage of patients with postoperative complications was 26.1% (2.1% Clavien 1, 14.6% Clavien 2, 8.3% Clavien 3, 1% Clavien 4). Benign tumors accounted for 12.5% of patients. PSM rate was 3.6% (3/84). The trifecta outcome was accomplished in 56.2% of patients. In the robotic group the mean operative time resulted significantly longer (175 vs.113 min, p Discussion The application of SE in tumors with adverse nephrometry seems particularly appropriate, in order to reduce the underuse of nephron sparing surgery in these clinical settings. Conclusions SE in highly complex renal masses is feasible, safe, and has satisfactory oncological results with a good preservation of the overall renal function.