Published: 2019-07-25

A prospective, multi-institutional study of perioperative morbidities in the patients of renal cell carcinoma undergoing either open nephron sparing surgery or robotic nephron sparing surgery in fifty cases

Mahesh Chandra, Seema Wasnik, Shailesh Karan


Background: Over the time, the nephron sparing surgery (NSS) has become ‘gold standard’ for treatment of T1a stage renal cell carcinoma (RCC) which saves precious renal tissue. We assessed and compared perioperative morbidities associated with open (ONSS) and robotic nephron sparing surgery (RNSS) in patients of T1a and T1b staged renal cell carcinoma.

Methods: This prospective study was carried out from April 2016 to March 2018. A total of fifty (n=50) RCC patients underwent open or robotic nephron sparing surgery. The demographic data and perioperative morbidities associated with both methods of NSS were recorded and comparison of parameters including warm-ischemia time (WIT), hospital stay, perioperative bleeding, impact of renal-pedicle clamping was made in T1a and T1b staged RCC patients.

Results: The most common perioperative morbidity was blood-loss and 12% patients had ≥500 ml loss. Significantly less intraoperative blood-loss was observed in RNSS compared to ONSS with decreased blood transfusion (BT), which decreased significantly after renal-pedicle clamping prior to RCC resection. Even In perioperative period, the blood loss was significantly less in RNSS patients. However, the warm ischemia time (WIT) and hospital stay was longer in patients of RNSS compared to ONSS. The WIT was prolonged in T1b compared to T1a lesions, irrespective NSS methods.

Conclusions: Although, the most common perioperative morbidity associated with NSS is blood-loss but RNSS had less perioperative morbidities compared to ONSS. The blood loss decreased significantly during intraoperative period after renal-pedicle clamping which resulted into decreased blood transfusion after NSS by either method. 



Renal, Carcinoma, Nephron, Robotic, Clamping, Morbidities

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Hollingsworth JM, Miller DC, Daignault S, Hollenbeck BK. Rising incidence of small renal masses: A need to reassess treatment effect. J Natl Cancer Inst. 2006;98:1331-40.

Godley P, Kim SW. Renal cell carcinoma. Curr Opin Oncol. 2002;14:280–5.

Campbell SC, Novick AC, Belldegrun A, BLUTE ML, Chow GK, Derweesh IH et al. Guideline for management of the clinical Tl renal mass. J Urol. 2009;182:1271-9.

Ljungberg B, Hanbury DC, Kuczyk MA, Merseburger AS, Mulders PF, Patard JJ, et al. Renal cell carcinoma guideline. Eur Urol. 2007;51:1502-10.

Pahernik S, Roos F, Rohrig B, Weisner C, Thuroff JW. Elective nephron sparing surgery for renal cell carcinoma larger than 4 cm. J Urol. 2008;179:71-4.

Pantuck AJ, Zisman A, Belldegrun AS. The changing natural history of renal cell carcinoma. J Urol. 2001;166:1611–23.

Siegel R, Naishadham D, Jemal A. Cancer statistics, 2013. CA Cancer J Clin. 2013;63:11–30.

Silverman SG, Israel GM, Herts BR, Richie JP. Management of the incidental renal mass. Radiology. 2008;249:16–31.

Parker AS, Cerhan JR, Janney CA, Lynch CF, Cantor KP. Smoking cessation and renal cell carcinoma. Ann Epidemiol. 2003;13:245–51.

Lipworth L, Tarone RE, McLaughlin JK. The epidemiology of renal cell carcinoma. J Urol. 2006;176:2353–8.

Campbell SC, Novick AC. Surgical technique and morbidity of elective partial nephrectomy. Semin Urol Oncol. 1995;13:281.

Steinbach F, Stockle M, Muller SC, Thuroff JW, Melchior SW, Stein R, et al. Conservative surgery of renal cell tumors in 140 patients: 21 years of experience. J Urol. 1992;148:24.

Belldegrun A, Tsui KH, deKernion JB, Smith RB. Efficacy of nephron-sparing surgery for renal cell carcinoma: analysis based on the new, 1997 Tumor-Node-Metastasis Staging System. J Clin Oncol. 1999;17:2868.

Campbell SC, Novick AC, Streem SB, Klein E, Licht. Complications of nephron sparing surgery for renal tumors. J Urol. 1994;151:1177.

Thrasher JB, Robertson JE, Paulson DF. Expanding indications for conservative renal surgery in renal cell carcinoma. Urology. 1994;43:160.

Poppel HV, Pozzo LD, Albrecht W, Matveev V, Bono A, Borkowski A, et al. A prospective Randomized EORTC Intergroup Phase 3 Study Comparing the Complications of Elective Nephron Sparing Surgery and Radical Nephrectomy for Low Stage Renal Cell Carcinoma. Eur Urol. 2007;51:1606-15.

Moll V, Becht E, Ziegler M. Kidney preserving surgery in renal cell tumors: indications, techniques and results in 152 patients. J Urol. 1993;150:319.

Duque JL, Loughlin KR, O’Leary MP, Kumar S, Richie JP. Partial nephrectomy: alternative treatment for selected patients with renal cell carcinoma. Urology. 1998;52:584.

Lerner SE, Hawkins CA, Blute ML, Grabner A, Wollen PC, Eickhot JT, et al. Disease outcome in patients with low stage renal cell carcinoma treated with nephron sparing or radical surgery. J Urol. 1996;155:1868.

Polascik TJ, Pound CR, Meng MV, Partin AW, Marshall FF. Partial nephrectomy technique, complications and pathological findings. J Urol. 1995;154:1312.

Benway BM, Bhayani SB, Rogers CG, Dulabon LM, Patel MN, Lipkin M, et al. Robot assisted partial nephrectomy versus laparoscopic partial nephrectomy for renal tumors: A multi-institutional analysis of perioperative outcomes. J Urol. 2009;182:866-73.

Boylu U, Basatac C, Yildirim U, Onol FF, and Gumus E. Comparison of surgical, functional, and oncological outcomes of open and robot assisted partial nephrectomy. J Minim Access Surg. 2015;11(1):72–7.

Simhan J, Smaldone MC, Tsai KJ, Li T, Reyes JM, Canter D, et al. Perioperative outcomes of robotic and open partial nephrectomy for moderately and highly complex renal lesions. J Urol. 2012;187:2000–4.

Lucas SM, Mellon MJ, Erntsberger L, Sundaram CP. A comparison of robotic, laparoscopic and open partial nephrectomy. JSLS. 2012;16:581–7.

Ficarra V, Minervini A, Antonelli A, Bhayani S, Guazzoni G, Longo N et al. A multicentre matched pair analysis comparing robotassisted versus open partial nephrectomy. BJU Int. 2014;113:936–41.

Serni S, Vittori G, Masieri L, Gacci M, Lapini A, Siena G et al. Robotic vs open simple enucleation for the treatment of T1a-T1b renal cell carcinoma: A single center matched-pair comparison. Urology. 2014;83:331–7.

Lee S, Oh J, Hong SK, Lee SE, Byun SS. Open versus robot assisted partial nephrectomy:Effect on clinical outcome. J Endo Urol. 2011;25:1181–5.

Patard JJ, Pantuck AJ, Crepel M, Lam JS, Bellec L, Albouy B et al. Morbidity and clinical outcome of nephron sparing surgery in relation to tumour size and indication. Eur Urol. 2007;52:148-54.