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A systematic review of robot-assisted partial nephrectomy outcomes for advanced indications:Large tumors(cT2-T3),solitary kidney,completely endophytic,hilar,recurrent,and multiple renal tumors

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Asian Journal of Urology 2023年第4期10卷 390-406页

作者： Savio Domenico Pandolfo Clara Cerrato Zhenjie Wu Antonio Franco Francesco Del Giudice Alessandro Sciarra Paolo Verze Giuseppe Lucarelli Ciro Imbimbo Sisto Perdonà Edward E.Cherullo Francesco Porpiglia Ithaar H.Derweesh Riccardo Autorino Department of Urology Rush University Medical CenterChicagoILUSA Department of Neurosciences Reproductive Sciences and Odontostomatology“Federico II”UniversityNaplesItaly Department of Urology University of VeronaVeronaItaly Department of Urology Changhai HospitalNaval Medical UniversityShanghaiChina European Association of Urology(EAU)Young Academic Urologists(YAU)Renal Cancer Working Group Arnhemthe Netherlands Department of Urology Sant’Andrea HospitalLa Sapienza UniversityRomeItaly Department of Maternal-Infant and Urologic Sciences La Sapienza UniversityPoliclinico Umberto I HospitalRomeItaly Department of Medicine and Surgery Scuola Medica SalernitanaUniversity of SalernoFiscianoItaly Department of Emergency and Organ Transplantation-Urology Andrology and Kidney Transplantation UnitUniversity of BariBariItaly Department Uro-Gynecology IRCCS G.Pascale FoundationNaplesItaly Department of Urology San Luigi Gonzaga HospitalUniversity of TurinOrbassanoItaly Department of Urology University of California San DiegoLa JollaCAUSA

Objective:Robot-assisted partial nephrectomy(RAPN)has become widely used for treatment of renal cell carcinoma and it is expanding in the field of complex renal masses.The aim of this systematic review was to analyze outcomes of RAPN for completely endophytic renal masses,large tumors(cT2-T3),renal cell carcinoma in solitary kidney,recurrent tumors,completely endophytic and hilar masses,and simultaneous and multiple tumors.Methods:A comprehensive search in the PubMed,Scopus,Web of Science,and Cochrane Central Register of Controlled Trials databases was performed in December 2022 for English language papers.The primary endpoint was to evaluate the role of RAPN in the setting of each category of complex renal masses considered.The secondary endpoint was to evaluate the surgical and functional outcomes.Results:After screening 1250 records,43 full-text manuscripts were selected,comprising over 8500 patients.Twelve and thirteen studies reported data for endophytic and hilar renal masses,respectively.Five and three studies reported outcomes for cT2-T3 and solitary kidney patients,respectively.Four studies focused on redo-RAPN for recurrent tumors.Two studies investigated simultaneous bilateral renal masses and five reports focused on multiple tumor excision in ipsilateral kidney.Conclusion:Over the past decade,evidence supporting the use of RAPN for the most challenging nephron-sparing surgery indications has continuously grown.Although limitations remain including study design and lack of detailed long-term functional and oncological outcomes,the adoption of RAPN for the included advanced indications is associated with favorable surgical outcomes with good preservation of renal function without compromising the oncological result.Certainly,a higher likelihood of complication might be expected when facing extremely challenging cases.However,none of these indications should be considered per se an exclusion criterion for performing RAPN.Ultimately,a risk-adapted approach should be employed.

关键词： Robot-assisted partial nephrectomy Complex renal mass Solitary kidney Larger tumors(cT2-T3) Endophytic and hilar mass recurrent tumor Simultaneous and multiple tumor

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