Robot-assisted partial nephrectomy (RAPN) is a safe and effective approach for nephron-sparing surgery (NSS) that is capable of providing patients with excellent short-term oncologic outcomes, according to the largest RAPN experience described to date.
Brian M. Benway, MD, of Washington University School of Medicine in Saint Louis, and collaborators reviewed data from 183 patients who underwent RAPN at four centers between 2006 and 2008. Subjects had a mean age of 59.3 years and a mean tumor size of 2.87 cm. The mean operative time was 210 minutes, the mean ischemic time was 23.9 minutes, and the mean estimated blood loss was 131.5 mL.
Of the excised tumors, 69% were malignant and 2.7% of these had positive surgical margins, Dr. Benway’s group reported in European Urology (2010; published online ahead of print). This relatively low rate of positive surgical margins is consistent with previous published laparoscopic series and lower than that observed in a large previously published RAPN study, the researchers noted.
The study revealed an 8.2% incidence of major complications. At up to 26 months of follow-up, the investigators observed no recurrences and no significant change in serum creatinine or estimated glomerular filtration rate from baseline.
“In experienced hands,” the authors concluded, “RAPN is a viable alternative to both the open and laparoscopic approaches to NSS, offering excellent short-term outcomes and cancer control.”