Reoperative Partial Nephrectomy-Does Previous Surgical Footprint Impact Outcomes?.

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Citation: Journal of Urology. 206(3):539-547, 2021 09.PMID: 33904762Institution: MedStar Washington Hospital CenterDepartment: Urology Residency-AdvancedForm of publication: Journal ArticleMedline article type(s): Journal ArticleSubject headings: *Kidney Neoplasms/su [Surgery] | *Nephrectomy/ae [Adverse Effects] | *Postoperative Complications/ep [Epidemiology] | *Reoperation/ae [Adverse Effects] | Adult | Aged | Blood Transfusion/sn [Statistics & Numerical Data] | Feasibility Studies | Female | Humans | Laparoscopy/ae [Adverse Effects] | Laparoscopy/mt [Methods] | Laparoscopy/sn [Statistics & Numerical Data] | Male | Middle Aged | Nephrectomy/mt [Methods] | Nephrectomy/sn [Statistics & Numerical Data] | Postoperative Complications/et [Etiology] | Postoperative Complications/th [Therapy] | Reoperation/mt [Methods] | Reoperation/sn [Statistics & Numerical Data] | Retrospective Studies | Risk Assessment/sn [Statistics & Numerical Data] | Robotic Surgical Procedures/ae [Adverse Effects] | Robotic Surgical Procedures/mt [Methods] | Robotic Surgical Procedures/sn [Statistics & Numerical Data] | Treatment OutcomeYear: 2021ISSN:
  • 0022-5347
Name of journal: The Journal of urologyAbstract: CONCLUSIONS: RePN is feasible using both open and robotic approaches. While the robotic approach was independently associated with fewer major complications, prior approach was not, implying that prior surgical approaches are less important to perioperative outcomes and in contributing to the overall surgical footprint.MATERIALS AND METHODS: A retrospective review of patients undergoing RePN was performed. Patients were assigned cohorts based on current and prior surgical approaches: open after open, open after minimally invasive surgery (MIS), robotic after open, and robotic after MIS cohorts. Perioperative outcomes were compared among cohorts. Factors contributing to complications were assessed.PURPOSE: Historically, open techniques have been favored over minimally invasive approaches for complex surgeries. We aimed to identify differences in perioperative outcomes, surgical footprints, and complication rates in patients undergoing either open or robotic reoperative partial nephrectomies (RePN).RESULTS: A total of 192 patients underwent RePN, including 103 in the open after open, 10 in the open after MIS, 47 in the robotic after open, and 32 in the robotic after MIS cohorts. The overall and major complication (grade >=3) rates were 65% and 19%, respectively. The number of blood transfusions, overall complications, and major complications were significantly lower in robotic compared to open surgical cohorts. On multivariate analysis, the robotic approach was protective against major complications (OR: 0.3, p=0.02) and estimated blood loss was predictive (OR: 1.03, p=0.004). Prior surgical approach was not predictive for major complications.All authors: Ahdoot MA, Ball MW, Bratslavsky G, Egan J, Friedberg NA, Gordhan C, Gurram S, Li W, Linehan WM, Metwalli AR, Yerram NKOriginally published: Journal of Urology. :101097JU0000000000001837, 2021 Apr 27Fiscal year: FY2022Fiscal year of original publication: FY2021Digital Object Identifier: Date added to catalog: 2021-06-07
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Journal Article MedStar Authors Catalog Article 33904762 Available 33904762

CONCLUSIONS: RePN is feasible using both open and robotic approaches. While the robotic approach was independently associated with fewer major complications, prior approach was not, implying that prior surgical approaches are less important to perioperative outcomes and in contributing to the overall surgical footprint.

MATERIALS AND METHODS: A retrospective review of patients undergoing RePN was performed. Patients were assigned cohorts based on current and prior surgical approaches: open after open, open after minimally invasive surgery (MIS), robotic after open, and robotic after MIS cohorts. Perioperative outcomes were compared among cohorts. Factors contributing to complications were assessed.

PURPOSE: Historically, open techniques have been favored over minimally invasive approaches for complex surgeries. We aimed to identify differences in perioperative outcomes, surgical footprints, and complication rates in patients undergoing either open or robotic reoperative partial nephrectomies (RePN).

RESULTS: A total of 192 patients underwent RePN, including 103 in the open after open, 10 in the open after MIS, 47 in the robotic after open, and 32 in the robotic after MIS cohorts. The overall and major complication (grade >=3) rates were 65% and 19%, respectively. The number of blood transfusions, overall complications, and major complications were significantly lower in robotic compared to open surgical cohorts. On multivariate analysis, the robotic approach was protective against major complications (OR: 0.3, p=0.02) and estimated blood loss was predictive (OR: 1.03, p=0.004). Prior surgical approach was not predictive for major complications.

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