# Contemporary Outcomes of Robot-Assisted Partial Nephrectomy: Results from Two European Referral Institutions

## TL;DR

This study reports on the outcomes of robot-assisted partial nephrectomy surgeries performed by experienced surgeons at two European centers, focusing on patient results and complications.

## Contribution

The study provides contemporary outcomes of robot-assisted partial nephrectomy from two referral centers with experienced surgeons.

## Key findings

- Trifecta was achieved in 74% of patients.
- Significant chronic kidney disease upstaging occurred in 9.4% of patients after one year.
- Higher R.E.N.A.L. scores and multiple lesions were associated with lower chances of achieving trifecta.

## Abstract

Available guidelines recommend performing nephron-sparing surgery in selected renal cell carcinoma (RCC) patients. In this study, we aim to provide a contemporary report of robot-assisted partial nephrectomy (RAPN) patient outcomes performed at two referral centers by experienced surgeons. A total of 333 RAPN patients treated between 2019 and 2021 were assessed. The median age was 65 (IQR: 57–73) years. Clinical stage distribution was as follows: 224 (67%) cT1a vs. 89 (26%) cT1b vs. 20 cT2 (7%). Trifecta was achieved in 74% (n = 240) of individuals. A total of 24 (7.2%) patients exhibited positive surgical margins. Significant chronic kidney disease (CKD) stage upstaging was recorded in 9.4% of patients after one year of follow-up. The following report represents a valid benchmark that could be used for individual patients counseling in the decision-making process.

Introduction: Available guidelines recommend performing nephron-sparing surgery in selected renal cell carcinoma (RCC) patients. Many studies provided robot-assisted partial nephrectomy (RAPN) functional and oncological outcomes, with most of these including a wide timespan and a number of surgeons with different experiences, which might lead to the heterogeneity of the results. In this study, we aim to provide a contemporary report of RAPN patient outcomes performed at two referral centers by experienced surgeons. Materials and Methods: Overall, 333 RAPN patients treated at two European referral centers between 2019 and 2021 were identified. Continuous and categorical variables were reported using medians and proportions. Multi-variable logistic regression (MLR) models were fitted to test predictors of off-clamp technique use and trifecta achievement. Results: The median age was 65 (IQR: 57–73) years. The clinical stage distribution was as follows: 224 (67%) cT1a vs. 89 (26%) cT1b vs. 20 cT2 (7%). The median warm ischemia time was 14 (10–18) minutes, with trifecta being achieved in 74% (n = 240) of patients. In MLR models predicting off-clamp surgery, an increasing R.E.N.A.L. score was independently associated with a lower chance of attempting such a technique (OR: 0.69, p-value < 0.001). In models predicting trifecta achievement, both a higher R.E.N.A.L. score (OR: 0.78, p-value = 0.007) and the presence of multiple lesions (OR: 0.29, p-value = 0.007) were independently associated with lower chances of reaching the outcome. Significant upstaging of chronic kidney disease (CKD) stage was recorded in 9.4% of patients after one year of follow-up. Conclusions: We reported the contemporary outcomes of patients treated with RAPN by highly experienced surgeons from two referral centers. This report represents a valid benchmark that could be used for individual patient counseling in the decision-making process.