Feasibility and Safety of Repeat Robot-Assisted Partial Nephrectomy for Ipsilateral Local Recurrence: A Case Series.

OBJECTIVES

To evaluate the feasibility, safety, and short-term oncological and functional outcomes of repeat robot-assisted partial nephrectomy (RAPN) for ipsilateral local recurrence of renal cell carcinoma after partial nephrectomy (PN) and describe the relevant surgical strategies.

METHODS

We retrospectively evaluated eight consecutive patients who underwent repeat RAPN between April 2019 and January 2026. Patient characteristics, perioperative outcomes, renal function, pathological findings, and adhesion severity were analyzed. Intraoperative adhesions were graded as minor or severe based on the surgeon's assessment.

RESULTS

Eleven ipsilateral recurrent tumors were analyzed in eight patients. Repeat RAPN was successfully performed in all patients without conversion to open surgery or radical nephrectomy. The median operative time, warm ischemia time, and estimated blood loss were 157 min, 15 min, and 50 mL, respectively. No major (Clavien-Dindo grade ≥ III) complications occurred. All malignant tumors were pT1a with negative surgical margins. At the median follow-up of 17.5 months, no local recurrence or distant metastasis was observed. The median eGFR values at 1 and 3 months were 57.1 and 55.7 mL/min/1.73 m2, respectively. Severe adhesions were more common among patients who did not receive anti-adhesion agents during initial surgery.

CONCLUSIONS

Repeat RAPN may be a feasible and safe salvage option for ipsilateral recurrence after PN, with acceptable early oncological and functional outcomes. Our findings suggest that anti-adhesion agent use during the initial PN may be associated with reduced adhesion-related difficulty during subsequent reoperations, although further validation is needed.