Robotic salvage partial nephrectomy following surgical and ablative therapies

ABSTRACT

Purpose:

Partial nephrectomies in the salvage setting after ablative or surgical therapy remain challenging cases that are underreported in the literature (¹-⁵). The aim of this video is to demonstrate techniques for robotic salvage partial nephrectomy to manage recurrent renal cell carcinoma (RCC) after failed prior partial nephrectomy and primary cryotherapy.

Materials and methods:

A 55-year-old man after previous robotic-assisted right partial nephrectomy presented with a 2.5 cm locally recurrent renal mass abutting the collecting system. A 59-year-old man with right renal cell carcinoma initially treated with cryoablation presented local recurrence. CT imaging demonstrated 2.6 cm right renal mass consistent with tumor recurrence at previous treatment site.

Results:

Both procedures were completed in under 180 minutes. Clamp time was 22 minutes after the previous partial nephrectomy and 25 minutes after previous cryotherapy. There were no perioperative complications. Pathology in both cases demonstrated pT1a clear cell RCC with negative margins. Both patients have since no evidence of recurrent disease on follow-up imaging at 1 and 2 years, respectively.

Conclusions:

Salvage robotic partial nephrectomy should be considered as a feasible treatment option after failure of initial therapy—surgical or ablative. A salvage procedure is often more challenging than its standard therapy-naïve counterpart due to development of dense inflammation after previous interventions. Despite this, robotic partial nephrectomies in the salvage setting can be safely carried out with good surgical outcomes, particularly when utilizing intraoperative ultrasound to identify tumor margins and key anatomy.

Available at: http://www.intbrazjurol.com.br/video-section/20240117_Autorino_et_al

Int Braz J Urol. 2024; 50 (Video #5): 373-4

REFERENCES

• ¹
  Martini A, Turri F, Barod R, Rocco B, Capitanio U, Briganti A, et al. Salvage Robot-assisted Renal Surgery for Local Recurrence After Surgical Resection or Renal Mass Ablation: Classification, Techniques, and Clinical Outcomes. Eur Urol. 2021;80:730-7. doi: 10.1016/j.eururo.2021.04.003.
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• ²
  Margue G, Michiels C, Allenet C, Dupitout L, Ricard S, Jambon E, et al. Feasibility of salvage robotic partial nephrectomy after ablative treatment failure (UroCCR-62 study). Minerva Urol Nephrol. 2022;74:209-15.
• ³
  Huang Y, Cen J, Tang Y, Yao H, Chen X, Chen W, et al. Robot-assisted partial nephrectomy for large complex renal cancer: step-by-step segmental artery unclamping. Int Braz J Urol. 2023;49:393-394. doi: 10.1590/S1677-5538.IBJU.2022.0572.
  » https://doi.org/10.1590/S1677-5538.IBJU.2022.0572
• ⁴
  Dos Reis RB, Feres RN, da Silva MC, Muglia VF, Rodrigues AA Júnior. The dilemma of partial nephrectomy and surgical upstaging. Int Braz J Urol. 2022;48:795-7. doi: 10.1590/S1677-5538.IBJU.2021.0859.1.
  » https://doi.org/10.1590/S1677-5538.IBJU.2021.0859.1
• ⁵
  Schulze L, Dubeux VT, Milfont JCA, Peçanha G, Ferrer P, Cavalcanti AG. Analysis of surgical and histopathological results of robot-assisted partial nephrectomy with use of three or four robotic arms: an early series results. Int Braz J Urol. 2022;48:493-500. doi: 10.1590/S1677-5538.IBJU.2021.0495.
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Publication Dates

• Publication in this collection
  27 May 2024
• Date of issue
  May-Jun 2024

History

• Received
  21 Feb 2024
• Accepted
  01 Mar 2024
• Published
  30 Mar 2024