Impact of Resection Technique on Perioperative Outcomes and Surgical Margins after Partial Nephrectomy for Localized Renal Masses: A Prospective Multicenter Study

PURPOSE: The impact of resection technique on partial nephrectomy (PN) outcomes is controversial. The aim of the study is to evaluate the pattern of resection techniques during PN and their impact on perioperative outcomes, acute kidney injury (AKI), positive surgical margins (PSM) and Trifecta achievement. MATERIALS AND METHODS: Data from consecutive patients with cT1-2N0M0 renal masses treated with PN at 16 referral Centres from September 2014 to March 2015 were prospectively collected. After PN, resection technique was classified by the surgeon as enucleation, enucleoresection and resection according to the SIB score (SIB score 0-2, 3-4 and 5, respectively). Multivariable logistic regression analysis was used to evaluate the potential impact of resection technique on postoperative surgical complications, PSM, AKI and Trifecta achievement. RESULTS: Overall, 507 patients were included. Resection technique was classified as enucleation in 266 (52%) patients, enucleoresection in 150 (30%) and resection in 91 (18%). Resection technique (enucleoresection as compared to both enucleation and resection) was the only significant predictor of positive surgical margins. Tumor complexity, surgical approach (open and laparoscopic, both compared to robotic) and resection technique (enucleoresection as compared to enucleation) were significant predictors of Clavien-Dindo grade ≥ 2 surgical complications. Surgical approach (open and laparoscopic, both compared to robotic), resection technique (enucleoresection as compared to enucleation) and warm ischemia time were significantly associated with postoperative AKI and Trifecta achievement. CONCLUSIONS: Resection techniques significantly impact on surgical complications, early functional outcomes and positive surgical margins after PN for localized renal masses.