Radiofrequency Ablation-Assisted Zero-Ischemia Robotic Laparoscopic Partial Nephrectomy: Oncologic and Functional Outcomes in 49 Patients

الملخص EN

Introduction and Objectives.

Robotic partial nephrectomy with peritumoral radiofrequency ablation (RFA-RPN) is a novel clampless technique.

We describe oncologic and functional outcomes in a prospective cohort.

Methods.

From May, 2007, to December, 2009, 49 consecutive patients with renal masses <7 cm underwent RFA-RPN.

During this period, only the RFA-RPN technique was utilized for all cases of partial nephrectomy.

Pre- and postoperative data were analyzed and compared to 36 consecutive patients who underwent LPN.

Results.

In total, 49 tumors were treated in the RFA-RPN group and 36 tumors in the comparison group.

Mean operative time was longer in the RFA-RPN group (370 min versus 293 min, p<0.001).

There were no significant differences in mean EBL (231 cc versus 250 cc, p=0.42), transfusion rate (8.2% versus 11.1%, p=0.7), or hospital stay (3.9 versus 4.4 days, p=0.2).

Two patients in the RFA-RPN (4.1%) and 1 (2.7%) patient in the comparison group had a positive surgical margin (p=0.75).

17 (34.7%) patients had a postoperative urine leak in the RFA-RPN group versus 2 (5.6%) patients in the comparison group (p=0.001).

Mean follow-up was 54 months versus 68.4 months in the comparison group.

There was no significant difference between the two groups regarding change in GFR (p=0.67).

There were 3 recurrences (6.1%) in the RFA-RPN group and 0 recurrences in the RPN group (p=0.23).

There were 3 deaths (6.1%) in the RFA-RPN group (one cancer specific) and 4 deaths (11.1%) in the RPN group (non-cancer specific) over the follow-up period (p=0.44).

Conclusions.

Our data suggests that this technique is associated with a similar degree of renal preservation but higher rates of postoperative urine leak and possibly higher rates of recurrence.