V04-04 Renorrhaphy With Cortical Coaptation for Complex Renal Hilar Tumors Following Partial Nephrectomy

You have accessJournal of UrologyAdrenal/Renal Oncology I (V04)1 May 2024V04-04 RENORRHAPHY WITH CORTICAL COAPTATION FOR COMPLEX RENAL HILAR TUMORS FOLLOWING PARTIAL NEPHRECTOMY Chi Hang Yee, Kelvin Kwok-Chai Ng, Janet Wui-Cheung Kung, Mandy Ho-Man Tam, Rossella Nicoletti, Yun-Sang Chan, Chi-Kwok Chan, Ka-Lun Lo, Wilson Hoi-Chak Chan, Peter Ka-Fung Chiu, Jeremy Yuen-Chun Teoh, and Chi-Fai Ng Chi Hang YeeChi Hang Yee , Kelvin Kwok-Chai NgKelvin Kwok-Chai Ng , Janet Wui-Cheung KungJanet Wui-Cheung Kung , Mandy Ho-Man TamMandy Ho-Man Tam , Rossella NicolettiRossella Nicoletti , Yun-Sang ChanYun-Sang Chan , Chi-Kwok ChanChi-Kwok Chan , Ka-Lun LoKa-Lun Lo , Wilson Hoi-Chak ChanWilson Hoi-Chak Chan , Peter Ka-Fung ChiuPeter Ka-Fung Chiu , Jeremy Yuen-Chun TeohJeremy Yuen-Chun Teoh , and Chi-Fai NgChi-Fai Ng View All Author Informationhttps://doi.org/10.1097/01.JU.0001009444.59519.d3.04AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Renal hilar tumors, even when small, present a unique technical challenge given their proximity to important vascular and collecting system structures which can then complicate renorrhaphy. We describe a technique for open and minimally invasive renorrhaphy for anterior and posterior renal hilar tumors with short-term safety and oncologic outcomes. METHODS: We retrospectively reviewed the perioperative and short-term cancer-specific outcomes of 24 patients who underwent open or robotic partial nephrectomy for complex renal hilar tumors between July 2013 and March 2022 at a single tertiary care center where the renorrhaphy was managed with anterior or posterior cortical coaptation. In this technique, the cortical lip is compressed with simple or running sutures rather than approximated across the renal tumor defect. Perioperative outcomes were stratified based on open or robotic approach and statistical comparisons were made with unpaired student t-tests. RESULTS: 24 patients (15 robotic and 9 open) with complex renal hilar tumors, median RENAL Nephrometry score 10, underwent a cortical coaptation-type renorrhaphy following resection. Median operative time, estimated blood loss (EBL), and length of stay (LOS) were 211 minutes, 230 cc, and 2 days, respectively. When stratified by open or robotic, there was a statistically significant reduction in operative time, EBL and LOS for robotic approach (p≤0.05). Renal cell carcinoma accounted for 20 of 24 tumors (14 clear cell vs 6 papillary). Positive margins were present in 3 of 22 cases. There were no postoperative complications greater than Clavien-Dindo classification of 1 (4 total) including no delayed hemorrhages. Two urine leaks were successfully managed conservatively. There was no statistically significant difference between preoperative and postoperative (>=1 year) GFR (median 80.1 vs 72 – p=0.32) and no local recurrences were identified at 3 and 12 months postoperatively. CONCLUSIONS: Renorrhaphy following wedge resection of complex hilar tumors can be safely and effectively performed with simple cortical coaptation. Perioperative and short-term outcomes from this study suggest that renal hilar tumors may be safely resected with minimal risk for delayed bleeding events and excellent cancer control. Statistical differences between robotic and open approaches may reflect selection related to case complexity. Limitations of the study include retrospective nature of the review and short-term follow up. Source of Funding: N/A © 2024 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 211Issue 5SMay 2024Page: e197 Advertisement Copyright & Permissions© 2024 by American Urological Association Education and Research, Inc.Metrics Author Information Chi Hang Yee More articles by this author Kelvin Kwok-Chai Ng More articles by this author Janet Wui-Cheung Kung More articles by this author Mandy Ho-Man Tam More articles by this author Rossella Nicoletti More articles by this author Yun-Sang Chan More articles by this author Chi-Kwok Chan More articles by this author Ka-Lun Lo More articles by this author Wilson Hoi-Chak Chan More articles by this author Peter Ka-Fung Chiu More articles by this author Jeremy Yuen-Chun Teoh More articles by this author Chi-Fai Ng More articles by this author Expand All Advertisement PDF downloadLoading ...