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

Aini: 1'0 assess perioperative , functional and oncologieal results or sirnple enucleation (SE) in patients with highly cornplex renal tumors (PADUA score 10-13). Materials and Methods: Data of 510 patients treated with SE for renal celi carcinorna (RCC) between July 2006 and August 2013 in our Department were gathered in a prospectively rnaintained database , Of these , 96 had highly cornplex renal tumors (PADUA 10-13, Figure lA) and were selected for this study, including 76 treated open and 20 with robotic SE (endoscopic robotic-assisted sirnple enucleation (ERASE». Converuional perioperative variables were collected and cornpared between open and robotie approach with univariate analysis. Survival status and functional data were gathered at follow-up. The probability of survival was estirnated by the Kaplan-Meier method. Results: Mean (range) clinical tumor diameter was 4.8 cm (interquartile range (lQR)=3-10). PADUA score was IO. Il, 12 and 13 in 57.3%, 29.2%, Il.5% and 2.1 'le 01' tumors , respectivcly. Overall. 19.8~ ofpatienrs had srage ~3 chronic kidney disease (CKD) and 17.7% an imperative/relative indication. Clamping of renal pedicle was used far alrnost al] patients (99%) with a rnean warrn ischernia tirne (WIT) of 19.2±5.7 minutes. Mean operative time was 126 minutes, mean estimated blood 108S (EBL) 200 cc and median length of stay (LOS) 6 days (lQR=5-7). Percentage of patients with postoperative cornplications was 26.1 % (2.1 % Clavien I, 14.6% Clavien 2,8.3% Clavien 3, l'le Clavien 4). Benign tumors accounted for 12.5% of patients. Positive surgical margin (PSM) rate was 3.6% (3/84). The trifecta outcorne was accornplished in 56.2% or patients. The mean±SD (rauge) follow-up was 54±26 (J4-96) months. The 5-year cancer-specific survival (CSS), recurrencc-free survival (RFS) and overall survival (OS) rates resulted 96.1%,90.8% and 88.0%, respectively. Preoperative, 3rd postoperative day, one rnonth postoperative and follow-up median erQR) estimated glornerular filtration rate (eGFR) was 79 (64-97),68 (5\-82), 76 (56-88) and 66 (50-81) ml/rnin/J.73 m2, respectively (Figure IB). Discussion and Conclusion: The optirnal oncological and functional results of SE suggest that ERASE is particularly appropriate to treat highly complex renal rnasses. minirniziug the loss of healthy renal volume and widening the indications of NSS according to the latest European Association of Urology (EAlJ) guidelines.