World journal of urology · 2026
Impact of resection bed management on postoperative outcomes after Robot-Assisted Partial Nephrectomy : a retrospective French Nationwide Study (UroCCR 215).
СтатьяМногоцентровое исследованиеНазвание и аннотация: Перевод в очереди
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Paillusson Dimitri, Margue Gaëlle, Champy Cécile, Doumerc Nicolas, Bigot Pierre, Bruyere Franck, Paparel Philippe, Surlemont Louis, Olivier Jonathan, Durand Matthieu, Branger Nicolas, Waeckel Thibaut, Fontenil Alexis, Vallee Maxime, Ouzaid Idir, Patard Jean-Jacques, Guillotreau Julien, Panthier Frédéric, Belas Olivier, Boissier Romain, Taha Fayek, Letang Nicolas, Parier Bastien, Lang Hervé, Dameron Constance, Verhoest Grégory, Sarrazin Clément, Bernhard Jean-Christophe, Bobet Soline, Karakachoff Mathilde, de Vergie Stéphane
Аннотация
INTRODUCTION: Kidney cancer remains a significant public health issue, mainly treated by surgery for localized tumors. RAPN is increasingly adopted due to its nephron-sparing advantage, yet optimal management of the renal resection bed remains controversial. Various techniques including parenchymal and/or capsular sutures or sutureless approaches, with or without adjunctive hemostatic agents (HA), are used, but their comparative safety and efficacy are not well established.
MATERIALS AND METHODS: This retrospective study analyzed data from 5,250 patients who underwent first RAPN in 26 centres, extracted from national UroCCR database. Patients were categorized into eight groups based on resection bed management techniques, with the main groups being double-layer sutures (DLS) and parenchymal sutures, with or without HA. Postoperative complications were classified using the Clavien-Dindo system. Multivariate logistic regression was performed adjusting for key confounders including age, sex, BMI, ASA score, RENAL-score, and preoperative creatinine. Secondary outcomes included length of hospital stay and comparison of HA use within suture and sutureless groups.
RESULTS: Intraoperative complications were rare (3.9%). Postoperative complications occurred in 19.1% of patients, with 3.1% experiencing severe complications (≥ grade 3). The "Sutureless without HA" group had a significantly higher rate of perioperative transfusions in multivariate analysis (17.8% vs. 6.8%; adjusted OR 3.3), although this did not translate into increased reinterventions or perirenal hematomas. No significant differences were found between groups regarding infectious or length of stay. Vascular complications were lower in "DLS with HA". The use of HA in sutureless groups was associated with shorter operative times and reduced transfusion rates, and no difference was observed in suture groups.
CONCLUSION: In this large, multicenter cohort, various hemostatic techniques during RAPN showed overall comparable safety profiles, except for a higher transfusion rate associated with sutureless without HA approaches, and a protective effect on vascular complications of DLS with HA.
MATERIALS AND METHODS: This retrospective study analyzed data from 5,250 patients who underwent first RAPN in 26 centres, extracted from national UroCCR database. Patients were categorized into eight groups based on resection bed management techniques, with the main groups being double-layer sutures (DLS) and parenchymal sutures, with or without HA. Postoperative complications were classified using the Clavien-Dindo system. Multivariate logistic regression was performed adjusting for key confounders including age, sex, BMI, ASA score, RENAL-score, and preoperative creatinine. Secondary outcomes included length of hospital stay and comparison of HA use within suture and sutureless groups.
RESULTS: Intraoperative complications were rare (3.9%). Postoperative complications occurred in 19.1% of patients, with 3.1% experiencing severe complications (≥ grade 3). The "Sutureless without HA" group had a significantly higher rate of perioperative transfusions in multivariate analysis (17.8% vs. 6.8%; adjusted OR 3.3), although this did not translate into increased reinterventions or perirenal hematomas. No significant differences were found between groups regarding infectious or length of stay. Vascular complications were lower in "DLS with HA". The use of HA in sutureless groups was associated with shorter operative times and reduced transfusion rates, and no difference was observed in suture groups.
CONCLUSION: In this large, multicenter cohort, various hemostatic techniques during RAPN showed overall comparable safety profiles, except for a higher transfusion rate associated with sutureless without HA approaches, and a protective effect on vascular complications of DLS with HA.