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.
Cancers. 2025 Jun 23*** epublish ***
Francesco Barletta, Nicola Frego, Mario de Angelis, Stefano Resca, Marco Ticonosco, Enrico Vecchio, Sara Tamburini, Alessandro Pissavini, Andrea Noya Mourullo, Bin K Kroon, Geert Smits, Bernke Papenburg, Edward Lambert, Frederick D'Hondt, Ruben De Groote, Peter Schatteman, Alexandre Mottrie, Geert De Naeyer
Unit of Urology, Division of Oncology, Gianfranco Soldera Prostate Cancer Lab, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy., Department of Urology, AZORG, 9300 Aalst, Belgium., Department of Urology, Rijnstate Hospital, 6815 AD Arnhem, The Netherlands.