SIMPLE TUMOR ENUCLEATION AND STANDARD PARTIAL NEPHRECTOMY HAVE SIMILAR PERIOPERATIVE RESULTS AND TRIFECTA OUTCOMES: COMPARISON BASED ON A MATCHED-PAIR ANALYSIS OF 400 PATIENTS FROM THE DEFINITIVE RESULTS OF RECORD1 PROJECT
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Data di Pubblicazione:
2014
Citazione:
SIMPLE TUMOR ENUCLEATION AND STANDARD PARTIAL NEPHRECTOMY HAVE SIMILAR PERIOPERATIVE RESULTS AND TRIFECTA OUTCOMES: COMPARISON BASED ON A MATCHED-PAIR ANALYSIS OF 400 PATIENTS FROM THE DEFINITIVE RESULTS OF RECORD1 PROJECT / A. Minervini, A. Antonelli, G. Bianchi, A. Tuccio, C. Fiori, S. Giancane, N. Longo, A. Mari, G. Martorana, V. Mirone, G. Morgia, F. Porpiglia, B. Rocco, B. Rovereto, R. Schiavina, S. Serni, C. Simeone, A. Volpe, V. Ficarra, M. Carini. ((Intervento presentato al convegno 87° Congresso Nazionale SIU Società Italiana di Urologia tenutosi a Firenze nel 2014.
Abstract:
Aim of the study
Simple tumor enucleation and Standard partial nephrectomy have similar perioperative results and trifecta
outcomes: comparison based on a matched-pair analysis of 400 patients from the definitive results of
RECORd1 project
Materials and methods
1055 patients treated with nephron sparing surgery (NSS) between January 2009 and December 2012
were evaluated. Overall, 200 patients who underwent STE were retrospectively matched with 200 patients
treated with SPN through a propensity score analysis based on preoperative variables. An intraoperative,
early post-operative and Trifecta comparison was performed between the two groups. Trifecta was defined
as simultaneous ischemia < 25 min, no surgical complication and absence of positive surgical margin
(PSM). Multivariable analysis was applied to predict factors independently associated with negative trifecta
outcome.
Results
STE and SPN presented similar WIT (18 vs 17 min) and intraoperative blood loss (200 vs 196 cc). STE
and SPN were also associated with similar surgical complication (11% vs 7.5%), surgical Clavien 3 (3% in
both groups) and Trifecta outcome (74% vs 73.5%) rate. The incidence of PSM was significantly lower in
patients treated with STE (1% vs 5%; p=0.02). Clinical diameter was significantly higher in patients with
negative trifecta outcome (3.5 vs 3 cm, p 0.01), but at the multivariable analysis, only
Discussion
The RECORd Project is a 4-Year prospective observational multicenter study promoted by the Italian
Society of Urology. This study confirms the results sorted out from the partial data of RECORd project. SE
and SPN presented similar overall and major surgical complications, PSM are significantly higher in PN.
Tumor diameter and tumor endophytical growth are the main predictive factors of no trifecta achieving.
Conclusions
To our knowledge this is the first multicenter matched-pair comparison of patients treated by STE and SPN.
The two techniques seems to have similar perioperative and trifecta outcomes. STE have lower rate of
PSM, but it needs further confirmation in a prospective study with central pathological revision. Endophytic
growth pattern remains an important predictive factor of negative trifecta outcome.
P 111
SLIDING CLIPS VERSUS SEPARATED STITCHES RENORRAPHY AT TIME OF
LOMBOTOMIC PARTIAL NEPHRECTOMY: A PROSPECTIVE RANDOMIZED TRIAL
L. Gallo, R. De Domenico, G. Quarto, R. Muscariello, D. Sorrentino, S. Perdonà (Napoli)
Aim of the study
to compare two different renorrhaphy techniques during open lombotomic partial nephrectomy
Materials and methods
All patients candidates to conservative renal surgery were recruited.Subjects were randomized in two
homogeneous and equal groups according to body mass index (BMI) and R.E.N.A.L. nephrometry score
(min 3 – max 12). We performed in both groups an open flank approach and the same tecnique for tumor
resection. We executed two different techniques of renorraphy. In group one separated CT-X needles
Vicryl® 0 sutures were placed on both sides of renal wound. A different numbers of sutures were placed
according to the size of the renal defect. Afterwards the two free ends of the suture were tied together above
a bolster of Tabotamb® to enforce the pressure on the resection area and to avoid tearing out the sutures. In
group two it was performed a “sliding clips” renorraphy technique: a knot was tied at the end of a 0 PDS®
suture. Above the knot, it was placed an Hem-o-Lock®. A running suture were then performed placing at
each passage of the needle at both side of the renal wound an Hem-o-Lock®. To tighten, the loose end of
each suture was grasped with a needle driver and tension was applied perpendicular to the cap
Tipologia IRIS:
14 - Intervento a convegno non pubblicato
Elenco autori:
A. Minervini, A. Antonelli, G. Bianchi, A. Tuccio, C. Fiori, S. Giancane, N. Longo, A. Mari, G. Martorana, V. Mirone, G. Morgia, F. Porpiglia, B. Rocco, B. Rovereto, R. Schiavina, S. Serni, C. Simeone, A. Volpe, V. Ficarra, M. Carini
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