MP67-02 GREATER IMPACT OF TUMOR DISSECTING TECHNIQUE ON TRIFECTA ACHIEVEMENT IN PATIENTS REQUIRING EXTENDED WARM ISCHEMIA DURING ROBOTIC-ASSISTED PARTIAL NEPHRECTOMY

You have accessJournal of UrologyKidney Cancer: Localized: Surgical Therapy V (MP67)1 May 2024MP67-02 GREATER IMPACT OF TUMOR DISSECTING TECHNIQUE ON TRIFECTA ACHIEVEMENT IN PATIENTS REQUIRING EXTENDED WARM ISCHEMIA DURING ROBOTIC-ASSISTED PARTIAL NEPHRECTOMY Yudai Ishiyama, Tsunenori Kondo, Kazuhiko Yoshida, Junpei Iizuka, and Toshio Takagi Yudai IshiyamaYudai Ishiyama , Tsunenori KondoTsunenori Kondo , Kazuhiko YoshidaKazuhiko Yoshida , Junpei IizukaJunpei Iizuka , and Toshio TakagiToshio Takagi View All Author Informationhttps://doi.org/10.1097/01.JU.0001009496.54470.10.02AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: In robotic partial nephrectomy (RAPN), extended warm ischemia time (WIT) is reported to have negative impact on postoperative renal function, yet it cannot be avoided in cases with complex or large tumors. The aim of this study was to identify specific factors associated with outcomes in the "extended warm ischemia" population. METHODS: We analyzed data from a prospectively generated multi-institutional RAPN database. Patients were divided into two groups based on their warm ischemia time: normal-WIT (nWIT, ≤20 minutes) and extended-WIT (eWIT, >20 minutes). We assessed factors such as baseline characteristics and surgical elements (transperitoneal or retroperitoneal, dissecting technique graded by Surface-Intermediate-Base [SIB] margin score) that contribute to postoperative trifecta achievement (90% eGFR preservation, negative surgical margin, and no perioperative complications) within each group. We then compared the results between the two groups. RESULTS: Of the 1,326 patients included in the database, 927 (69.9%) and 399 (30.1%) were included in the nWIT (mean WIT: 13.6 minutes) and eWIT (28.3 minutes) groups, respectively. Patients in the eWIT group had larger tumor size and RENAL nephrometry score, more patients were operated via transperitoneal approach, and the SIB margin score was significantly lower than that of the nWIT group. Trifecta achievement rate was significantly different between the groups (45.9 vs. 67.8%, p<0.001). In nWIT group RENAL nephrometry score, WIT, and SIB margin score were significant predictors of Trifecta achievement, while sex, age, and SIB margin score were for eWIT group. In multivariable model comprised of above variables, both SIB margin score and WIT were independently predicting Trifecta achievement in nWIT group, while only SIB margin score was independent in eWIT group. CONCLUSIONS: For patients with extended warm ischemia during RAPN, tumor dissecting technique may be more important than extra WIT in predicting postoperative outcomes. Download PPTDownload PPT Source of Funding: None © 2024 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 211Issue 5SMay 2024Page: e1096 Advertisement Copyright & Permissions© 2024 by American Urological Association Education and Research, Inc.Metrics Author Information Yudai Ishiyama More articles by this author Tsunenori Kondo More articles by this author Kazuhiko Yoshida More articles by this author Junpei Iizuka More articles by this author Toshio Takagi More articles by this author Expand All Advertisement PDF downloadLoading ...