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A contemporary series comparing perioperative outcomes following robotic partial nephrectomy to open partial nephrectomy in pediatric patients with poorly functioning renal moieties
Archana Rajender, MD, Briony K. Varda, MD, Joseph Badway, BS, Ashley Wietsma, MD, Richard Yu, MD, PhD, Richard S. Lee, MD.
Boston Children's Hospital, Boston, MA, USA.
BACKGROUND: Small series about the initial use of robotic partial nephrectomy (RALPN) in children exist. Contemporary data, excluding cases performed during an era of robotic adoption, do not. The aim of this study is to compare surgical outcomes in a contemporary cohort of patients undergoing either RALPN or open partial nephrectomy (OPN).
METHODS: We performed a single-institution retrospective review of RALPN and OPN between 2/2007 and 7/2014. Patient characteristics (age, gender, race, ASA score, laterality, affected moiety, affected moiety function, surgical indication and urologic history), procedure characteristics (surgeon, operative time [OT] and intraoperative complications) and postoperative outcomes (LOS, complications, readmission and improvement) were collected. PNs for renal masses were excluded. Descriptive statistics were calculated; all statistical tests were 2-sided with a p<0.05 statistically significant.
RESULTS: 46 partial nephrectomies (PN) were performed: 3 patients with renal masses were excluded, resulting in 27 RALPNs and 16 OPNs. Median follow up was 2.7 years for OPN and 1.1 for RALPN (p=0.03). RALPN patients were older (3.5 vs. 0.7 years, p=0.002), otherwise there was no difference in baseline characteristics. In both groups, the majority of patients had complete duplication (95.3%) and a dysplastic upper moiety (64.3%) with a mean function of 4.1% (±2.9%). Severe reflux accounted for the majority of lower moiety dysplasia. Mean OT was similar (RALPN 206 vs. OPN 195 minutes, p=0.5), but RALPN had a shorter LOS (1 vs. 3 days; p=0.002). There were no intraoperative complications in either group. Six patients had 7 postoperative complications (4 OPN vs. 3 RALPN). For OPN, complications included a seizure, prolonged intubation due to oversedation, intraoperative bleeding requiring transfusion, and recurrent febrile urinary tract infections (UTI). For RALPN, complications included a chronic fluid collection requiring IR drainage, an abscess with concurrent UTI, and a C. difficile infection. There was no significant loss in size of the residual moiety in either group. Both groups demonstrated clinical improvement at follow up (p=0.43).
CONCLUSIONS: For pediatric PN, the RALPN has similar safety and OT to OPN. Importantly, there was no adverse affect on the residual renal moiety despite a minimally-invasive, upper tract approach. RALPN offers the advantage of a shorter LOS. This study is limited by small sample sizes; larger studies are needed.
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