Comparison of perioperative outcomes among patients with exophytic, mesophytic, and endophytic renal tumors undergoing robot‐assisted partial nephrectomy

• Published in: International journal of urology Vol. 29; no. 9; pp. 1026 - 1030
• Main Authors: Motoyama, Daisuke, Ito, Toshiki, Sugiyama, Takayuki, Otsuka, Atsushi, Miyake, Hideaki
• Format: Journal Article
• Language: English
• Published: Australia Wiley Subscription Services, Inc 01.09.2022
• Subjects: Computed tomography; Endophytes; endophytic tumor; exophytic tumor; Ischemia; Kidneys; mesophytic tumor; Nephrectomy; Parenchyma; Robotic surgery; Robots; robot‐assisted partial nephrectomy; Tumors; mesophytic tumor; exophytic tumor; endophytic tumor; robot-assisted partial nephrectomy
• DOI: 10.1111/iju.14946
• ISSN: 0919-8172; 1442-2042

Objectives It has been well documented that partial nephrectomy for completely endophytic renal tumors is a highly challenging procedure accompanied by several technical difficulties even with the assistance of a robotic surgical system. This study aimed to compare perioperative variables among patients with exophytic, mesophytic, and endophytic renal tumors undergoing robot‐assisted partial nephrectomy. Methods This study retrospectively included 265 consecutive patients with localized small renal masses undergoing robot‐assisted partial nephrectomy at our institution. In this study, completely endophytic tumor was defined as the mass totally covered by renal healthy parenchyma, and according to the points for the ‘E' domain of RENAL nephrometry score based on preoperative computed tomography, subjects were classified into three groups as follows: exophytic, mesophytic, and endophytic tumor groups, and perioperative outcomes among these groups were compared. Results Of 265 patients, 127, 112, and 26 were classified into the exophytic, mesophytic, and endophytic tumor groups, respectively. A significantly smaller tumor diameter was observed in the endophytic group than in the other groups (P < 0.001), whereas the RENAL nephrometry score was significantly higher (P < 0.001). In addition, the warm ischemia time in the endophytic tumor group was significantly longer than that in other groups (P = 0.009); however, no significant difference in the trifecta achievement was noted among the three groups. Conclusions This study suggests that robot‐assisted partial nephrectomy for patients with completely endophytic tumors can be regarded as a feasible approach without marked impairment of perioperative outcomes; however, further investigation of the long‐term functional and oncological outcomes in these patients is required.