MP24: Kidney Cancer: Localized: Surgical Therapy I
MP24-14: A propensity matched comparison of the Perioperative Outcomes between Single-Port and Multi-Port Robotic Assisted Partial Nephrectomy
Saturday, May 14, 2022
8:45 AM – 10:00 AM
Location: Room 222
Kennedy E. Okhawere*, New York City , NY, Alp Tuna Beksac, Cleveland, OH, Michael Wilson, Talia G. Korn, Kirolos N Meilika, New York City , NY, Robert Harrison, Hackensack, NJ, Luca Morgantini, Chicago, IL, Mutahar Ahmed, Hackensack, NJ, Reza Mehrazin, New York City , NJ, Ronney Abaza, Columbus, OH, Daniel D. Eun, Philadelphia, PA, Akshay Bhandari, Miami, FL, Ashok K. Hemal, Winston-Salem, NC, James Porter, Seattle, WA, Michael D. Stifelman, Hackensack, NJ, Jihad Kaouk, Cleveland, OH, Simone Crivellaro, Chicago, IL, Ketan K. Badani, New York City , NY
Introduction: Single-port (SP) robotic surgery is a new technology and early in its adoption curve. There has been significant interest in utilizing this platform for partial nephrectomy. The goal of this study is to compare the perioperative outcomes of single port to multiport robotic technology.
Methods: This is a cohort study of patients who have undergone robotic-assisted partial nephrectomy using a multi-institutional database of 9 institutions in the United States between 2006 and 2021. The outcomes of interest were perioperative: operative time, ischemia time, estimated blood loss (EBL), length of hospital stay (LOS), positive margin rate, and any complication rate. Baseline demographic, clinical, and tumor-specific characteristics and perioperative outcomes were compared between multiport (MP) and single port (SP) using ?², Fisher’s exact, and Mann-Whitney U test in the overall cohort and in a 1:1 propensity score-matched cohort, adjusting for baseline characteristics and surgeons.
Results: A total of 3,008 patients were included in this study: multiport (n=2,860, 95.08%) and single port (n=148, 4.92%). After propensity matching, 121(50.00%) SP patients were matched with 121(50.00%) MP patients. Matched SP patients (59 years [IQR: 51, 68]) had similar median age when compared to the MP patients (60 years [IQR: 49, 69]). Compared to matched MP group, the matched SP had a longer median ischemia (16.0 mins [IQR: 11.5, 25.0] vs 13.2 mins [IQR: 10.0, 17.0]; p =0.0001). Although the EBL (50ml [IQR: 25, 100] vs 50ml [IQR: 50, 100]; p =0.002) and LOS (1 day [IQR: 1, 1] vs 1 day [IQR: 1, 2]; p =0.001) were the same, the mean rank sum was significantly lower in the single port groups. Operative time (138 mins [IQR: 113, 170] vs 128 mins [IQR: 90, 174]; p =0.140), positive margin rate (3.31% vs 7.44; p =0.254) and any complication rate (4.96% vs 9.09%; p= 0.209) were similar between the two groups.
Conclusions: SP partial nephrectomy presented longer ischemia time, lower EBL, lower LOS, similar operative time, similar positive margin and complication rates when compared to multi-port. This early data is encouraging. However, the role of SP requires further study and should evaluate safety and long-term data when compared to the standard multi-port technique.