Tumor rupture during robot-assisted partial nephrectomy (RAPN) poses oncological risks, including potential malignant cell spread and recurrence. Despite these risks, standardized guidelines for defining, managing, and assessing risk factors of tumor rupture in RAPN are lacking. This Delphi consensus study aimed to frame the definition, risk factors, and oncological implications of tumor rupture in RAPN, as well as to propose management strategies.
Using a modified Delphi method, a steering committee from multiple urological societies (the RUPTURE project) led a consensus-building study that followed the ACcurate COnsensus Reporting Document (ACCORD) checklist. A panel of international experts participated in a two-phase Delphi survey, rating their agreement with statements on tumor rupture, risk factors, and management in RAPN. Consensus was defined as ≥70% agreement, with unresolved statements discussed in an online meeting and subjected to a second voting round.
Thirty-three experts evaluated 58 statements. Consensus was reached on 33% of statements in the first round and 37.5% in the second round. Tumor rupture was defined, with risk factors including larger tumor size, complexity, and endophytic growth patterns. Recommended management strategies focused on minimizing tumor spillage by suctioning-rather than grasping-the cancerous tissue, and promptly securing the specimen in an endobag. Routine conversion to radical nephrectomy was not advised unless unresectable tumor remnants were found. Tumor rupture was not linked to distant metastasis, although its oncological impact varied by the rupture extent (ie, gross rupture vs focal; tumor spilled out macroscopically completely removed vs not).
This consensus forms a basis for future research on tumor rupture in RAPN, emphasizing standardized definitions and uniform management strategies. Empirical validation through future clinical research is warranted.
This research looks at tumor rupture during robotic kidney surgery, which can happen but is rare. The study involved a panel of experts who discussed finding a consensus on when it is more likely to occur and how to manage it effectively to reduce risks. It was also emphasized that while a rupture may not always lead to cancer spreading, the impact on a patient's health can vary and is yet to be determined.
European urology open science. 2025 Apr 15*** epublish ***
Riccardo Bertolo, Alessandro Antonelli, Axel Bex, Christopher Anderson, Riccardo Autorino, Neil Barber, Ketan Badani, Ravi Barod, Karim Bensalah, Jean-Christophe Bernhard, Alberto Breda, Umberto Capitanio, Ben Challacombe, Simone Crivellaro, Ruben De Groote, Ithaar Derweesh, Antonio Galfano, Nina Harke, Jihad Kaouk, Alexander Kutikov, Kris Maes, Andrea Minervini, Maria Carmen Mir Maresma, Francesco Montorsi, Francesco Porpiglia, Jim Porter, Riccardo Schiavina, Stefan Siemer, Giuseppe Simone, Karim Touijer, Christophe Vaessen, Alessandro Volpe, Zhenjie Wu, Patricia Zondervan, Paul Russo, María José Ribal, Alexandre Mottrie
Department of Urology, University of Verona, Azienda Ospedaliera Universitaria Integrata, Borgo Trento Hospital, Verona, Italy., Department of Urology, Royal Free London NHS Foundation Trust, University College London, London, UK., Department of Urology, St George's Hospital, London, UK., Department of Urology, Rush University Medical Center, Chicago, IL, USA., Urology Department, Frimley NHS Foundation Trust, Camberley, UK., Icahn School of Medicine at Mount Sinai, New York, NY, USA., Department of Urology, University of Rennes, Rennes, France., Department of Urology, CHU of Bordeaux, Bordeaux, France., Department of Urology, Fundació Puigvert, Autonoma University of Barcelona, Barcelona, Spain., IRCCS San Raffaele Scientific Institute, Urological Research Institute (URI), Milan, Italy., Guy's and St Thomas' NHS Foundation Trust, London, UK., Department of Urology, University of Illinois at Chicago, Chicago, IL, USA., Department of Urology, Onze-Lieve-Vrouw Ziekenhuis, Aalst, Belgium., Department of Urology, UC San Diego Health System, La Jolla, CA, USA., Department of Urology, Niguarda Hospital, Milan, Italy., Department of Urology, Hannover Medical School, Hannover, Germany., Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA., Division of Urologic Oncology, Department of Surgical Oncology, Fox Chase Cancer Center, Philadelphia, PA, USA., Department of Urology, Hospital Da Luz Lisboa, Lisbon, Portugal., Department of Experimental and Clinical Medicine, Unit of Oncologic Minimally-Invasive Urology and Andrology, University of Florence, Careggi Hospital, Florence, Italy., Servicio de Urología, Fundación Investigación Hospital IMED Valencia, Valencia, Spain., Division of Urology, Department of Oncology, School of Medicine, San Luigi Gonzaga Hospital, University of Turin, Orbassano, Turin, Italy., Swedish Urology Group, Swedish Medical Center, Seattle, WA, USA., Division of Urology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy., Department of Urology, Urologic Oncology and Robot-assisted Surgery, St. Antonius Hospital, Gronau, Germany., IRCCS "Regina Elena" National Cancer Institute, Department of Urology, Rome, Italy., Department of Surgery, Urology Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA., Urology, GRC 5, Predictive Onco-Urology, APHP, Pitié-Salpêtrière Hôpital, Sorbonne University, Paris, France., Division of Urology, Department of Translational Medicine, Università del Piemonte Orientale, Novara, Italy., Department of Urology, Changhai Hospital, Naval Medical University, Shanghai, China., Department of Urology, Amsterdam University Medical Centers, Cancer Center Amsterdam, University of Amsterdam, Amsterdam, The Netherlands., Department of Urology, Hospital Clínic de Barcelona, Barcelona, Spain.