3d395ffef8b65f1eec564cfe3b88d541 309050.pdf eb6fdf961b031f35c621e7cc584e0e569a5f1ab9 309050.pdf 9bad1eebcdd25fb43924234b2b1c5de138b5b0494ff7675fcfd3d04890cd833e 309050.pdf Title: Surgical Experience and Functional Outcomes after Laparoscopic and Robot-Assisted Partial Nephrectomy: Results from a Multi-Institutional Collaboration Subject: Background: In patients treated with partial nephrectomy, prior evidence showed that peri-operative outcomes, such as complications and ischemia time, improved as a function of the surgical experience of the surgeon, but data on functional outcomes after surgery are still scarce. Methods: We retrospectively analyzed data of 4011 patients with a single, unilateral cT1a-b renal mass treated with laparoscopic or robot-assisted partial nephrectomy. The operations were performed by 119 surgeons at 22 participating institutions between 1997 and 2022. Multivariable models investigated the association between surgical experience (number of prior operations) and acute kidney injury (AKI) and recovery of at least 90% of baseline estimated glomerular filtration rate (eGFR) 1 yr after partial nephrectomy. The adjustment for case mix included age, Body Mass Index, preoperative serum creatinine, clinical T stage, PADUA score, warm ischemia time, pathologic tumor size, and year of surgery. Results: A total of 753 (19%) and 3258 (81%) patients underwent laparoscopic and robot-assisted partial nephrectomy, respectively. Overall, 37 (31%) and 55 (46%) surgeons contributed only to laparoscopic and robotic learning curves, respectively, whereas 27 (23%) contributed to the learning curves of both approaches. In the laparoscopic group, 8% and 55% of patients developed AKI and recovered at least 90% of their baseline eGFR, respectively. After adjusting for confounders, we did not find evidence of an association between surgical experience and AKI after laparoscopic partial nephrectomy (odds ratio [OR]: 0.9992; 95% confidence interval [CI]: 0.9963, 1.0022; p = 0.6). Similar results were found when 1-year renal function was the outcome of interest (OR: 0.9996; 95% CI: 0.9988, 1.0005; p = 0.5). Among patients who underwent robot-assisted partial nephrectomy, AKI occurred in 11% of patients, whereas 54% recovered at least 90% of their baseline eGFR. On multivariable analyses, the relationship between surgical experience and AKI after surgery was not statistically significant (OR: 1.0015; 95% CI: 0.9992, 1.0037; p = 0.2), with similar results when the outcome of interest was renal function one year after surgery (OR: 1.0001; 95% CI: 0.9980, 1.0022; p = 0.9). Virtually the same findings were found on sensitivity analyses. Conclusions: In patients treated with laparoscopic or robot-assisted partial nephrectomy, our data suggest that the surgical experience of the operating surgeon might not be a key determinant of functional recovery after surgery. This raises questions about the use of serum markers to assess functional recovery in patients with two kidneys and opens the discussion on what are the key steps of the procedure that allowed surgeons to achieve optimal outcomes since their initial cases. Keywords: partial nephrectomy; functional outcomes; acute kidney injury; robot-assisted surgery; learning curve; surgical experience Author: Carlo Andrea Bravi, Paolo Dell’Oglio, Angela Pecoraro, Zine-Eddine Khene, Riccardo Campi, Pietro Diana, Chiara Re, Carlo Giulioni, Alp Tuna Beksac, Riccardo Bertolo, Tarek Ajami, Kennedy Okhawere, Margaret Meagher, Arman Alimohammadi, Marco Borghesi, Andrea Mari, Daniele Amparore, Marco Roscigno, Umberto Anceschi, Giuseppe Simone, Nazareno Suardi, Antonio Galfano, Riccardo Schiavina, Federico Dehò, Karim Bensalah, Abdullah Erdem Canda, Vincenzo Ferrara, Antonio Alcaraz, Xu Zhang, Carlo Terrone, Shahrokh Shariat, Francesco Porpiglia, Alessandro Antonelli, Jihad Kaouk, Ketan Badani, Andrea Minervini, Ithaar Derweesh, Alberto Breda, Alexandre Mottrie, Francesco Montorsi and Alessandro Larcher Creator: LaTeX with hyperref Producer: pdfTeX-1.40.25 CreationDate: Thu Oct 10 03:49:30 2024 CEST ModDate: Thu Oct 10 03:52:19 2024 CEST Custom Metadata: no Metadata Stream: no Tagged: no UserProperties: no Suspects: no Form: none JavaScript: no Pages: 12 Encrypted: no Page size: 595.276 x 841.89 pts (A4) Page rot: 0 File size: 628527 bytes Optimized: no PDF version: 1.7 name type encoding emb sub uni object ID ------------------------------------ ----------------- ---------------- --- --- --- --------- WLFTRW+VnURWPalladioL-Bold Type 1 Custom yes yes yes 10 0 ILDFYH+URWPalladioL-Bold Type 1 Custom yes yes yes 16 0 XBIAUP+URWPalladioL-Roma Type 1 Custom yes yes yes 22 0 CTXWGF+URWPalladioL-Ital Type 1 Custom yes yes yes 27 0 AQNFLW+VnURWPalladioL Type 1 Custom yes yes yes 32 0 XPUSBJ+TimesNewRomanPS-BoldItalicMT Type 1C WinAnsi yes yes no 48 0 BSDWLC+TimesNewRomanPSMT Type 1C WinAnsi yes yes no 51 0 QLBIEB+URWPalladioL-BoldItal Type 1 Custom yes yes yes 77 0 IKKWKP+CMSY10 Type 1 Builtin yes yes yes 82 0 LADCFD+PalatinoLinotype,Bold TrueType WinAnsi yes yes no 97 0 LADCFE+PalatinoLinotype CID TrueType Identity-H yes yes yes 100 0 LADCFF+PalatinoLinotype TrueType WinAnsi yes yes no 106 0 LADCFH+PalatinoLinotype,Italic TrueType WinAnsi yes yes no 109 0 LADCMH+PalatinoLinotype,BoldItalic TrueType WinAnsi yes yes no 112 0 LADDEF+PalatinoLinotype TrueType MacRoman yes yes no 115 0 LADCFD+PalatinoLinotype,Bold TrueType WinAnsi yes yes no 125 0 LADCFF+PalatinoLinotype TrueType WinAnsi yes yes no 128 0 LADCFH+PalatinoLinotype,Italic TrueType WinAnsi yes yes no 131 0 LADCMH+PalatinoLinotype,BoldItalic TrueType WinAnsi yes yes no 134 0 LADDEF+PalatinoLinotype TrueType MacRoman yes yes no 137 0 Jhove (Rel. 1.28.0, 2023-05-18) Date: 2025-03-15 02:42:50 CET RepresentationInformation: 309050.pdf ReportingModule: PDF-hul, Rel. 1.12.4 (2023-03-16) LastModified: 2025-03-14 13:28:51 CET Size: 628527 Format: PDF Version: 1.7 Status: Well-Formed and valid SignatureMatches: PDF-hul MIMEtype: application/pdf PDFMetadata: Objects: 324 FreeObjects: 1 IncrementalUpdates: 0 DocumentCatalog: PageLayout: SinglePage PageMode: UseNone Outlines: Item: Title: Introduction Destination: section.1 Item: Title: Methods Destination: section.2 Children: Item: Title: Patient Population Destination: subsection.2.1 Item: Title: Outcome Definition Destination: subsection.2.2 Item: Title: Statistical Analyses Destination: subsection.2.3 Item: Title: Results Destination: section.3 Children: Item: Title: Descriptive Characteristics of Surgeons Included in the Study Destination: subsection.3.1 Item: Title: Surgical Experience and Functional Outcomes Destination: subsection.3.2 Children: Item: Title: Laparoscopic Partial Nephrectomy Destination: subsubsection.3.2.1 Item: Title: Robot-Assisted Partial Nephrectomy Destination: subsubsection.3.2.2 Item: Title: Sensitivity Analyses Destination: subsection.3.3 Item: Title: Discussion Destination: section.4 Children: Item: Title: Discussion Destination: subsection.4.1 Item: Title: Limitations Destination: subsection.4.2 Item: Title: Conclusions Destination: section.5 Item: Title: References Destination: appendix.A. Info: Title: Surgical Experience and Functional Outcomes after Laparoscopic and Robot-Assisted Partial Nephrectomy: Results from a Multi-Institutional Collaboration Author: Carlo Andrea Bravi, Paolo Dell’Oglio, Angela Pecoraro, Zine-Eddine Khene, Riccardo Campi, Pietro Diana, Chiara Re, Carlo Giulioni, Alp Tuna Beksac, Riccardo Bertolo, Tarek Ajami, Kennedy Okhawere, Margaret Meagher, Arman Alimohammadi, Marco Borghesi, Andrea Mari, Daniele Amparore, Marco Roscigno, Umberto Anceschi, Giuseppe Simone, Nazareno Suardi, Antonio Galfano, Riccardo Schiavina, Federico Dehò, Karim Bensalah, Abdullah Erdem Canda, Vincenzo Ferrara, Antonio Alcaraz, Xu Zhang, Carlo Terrone, Shahrokh Shariat, Francesco Porpiglia, Alessandro Antonelli, Jihad Kaouk, Ketan Badani, Andrea Minervini, Ithaar Derweesh, Alberto Breda, Alexandre Mottrie, Francesco Montorsi and Alessandro Larcher Subject: Background: In patients treated with partial nephrectomy, prior evidence showed that peri-operative outcomes, such as complications and ischemia time, improved as a function of the surgical experience of the surgeon, but data on functional outcomes after surgery are still scarce. Methods: We retrospectively analyzed data of 4011 patients with a single, unilateral cT1a-b renal mass treated with laparoscopic or robot-assisted partial nephrectomy. The operations were performed by 119 surgeons at 22 participating institutions between 1997 and 2022. Multivariable models investigated the association between surgical experience (number of prior operations) and acute kidney injury (AKI) and recovery of at least 90% of baseline estimated glomerular filtration rate (eGFR) 1 yr after partial nephrectomy. The adjustment for case mix included age, Body Mass Index, preoperative serum creatinine, clinical T stage, PADUA score, warm ischemia time, pathologic tumor size, and year of surgery. Results: A total of 753 (19%) and 3258 (81%) patients underwent laparoscopic and robot-assisted partial nephrectomy, respectively. Overall, 37 (31%) and 55 (46%) surgeons contributed only to laparoscopic and robotic learning curves, respectively, whereas 27 (23%) contributed to the learning curves of both approaches. In the laparoscopic group, 8% and 55% of patients developed AKI and recovered at least 90% of their baseline eGFR, respectively. After adjusting for confounders, we did not find evidence of an association between surgical experience and AKI after laparoscopic partial nephrectomy (odds ratio [OR]: 0.9992; 95% confidence interval [CI]: 0.9963, 1.0022; p = 0.6). Similar results were found when 1-year renal function was the outcome of interest (OR: 0.9996; 95% CI: 0.9988, 1.0005; p = 0.5). Among patients who underwent robot-assisted partial nephrectomy, AKI occurred in 11% of patients, whereas 54% recovered at least 90% of their baseline eGFR. On multivariable analyses, the relationship between surgical experience and AKI after surgery was not statistically significant (OR: 1.0015; 95% CI: 0.9992, 1.0037; p = 0.2), with similar results when the outcome of interest was renal function one year after surgery (OR: 1.0001; 95% CI: 0.9980, 1.0022; p = 0.9). Virtually the same findings were found on sensitivity analyses. Conclusions: In patients treated with laparoscopic or robot-assisted partial nephrectomy, our data suggest that the surgical experience of the operating surgeon might not be a key determinant of functional recovery after surgery. This raises questions about the use of serum markers to assess functional recovery in patients with two kidneys and opens the discussion on what are the key steps of the procedure that allowed surgeons to achieve optimal outcomes since their initial cases. 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