The impact of robotic surgery access on the management of patients with clinical stage I kidney tumors

Authors

  • Francis Lemire Ottawa Hospital Research Institute and the University of Ottawa, Ottawa, ON, Canada
  • MengQi Zhang Ottawa Hospital Research Institute and the University of Ottawa, Ottawa, ON, Canada
  • Patrick Anderson Ottawa Hospital Research Institute and the University of Ottawa, Ottawa, ON,
  • Antonio Finelli Princess Margaret Cancer Centre, University Health Network and University of Toronto, Toronto, ON, Canada
  • Ricardo A. Rendon Dalhousie University and Queen Elizabeth II Health Sciences Centre, Halifax, NS, Canada
  • Simon Tanguay McGill University and McGill University Health Centre, Montréal, QC, Canada
  • Rahul Bansal McMaster University, Hamilton, ON, Canada
  • Bimal Bhindi Southern Alberta Institute of Urology, University of Calgary, Calgary, AB, Canada
  • Alan I. So University of British Columbia, Vancouver, BC, Canada
  • Frédéric Pouliot Centre Hospitalier Universitaire de Québec, Université Laval, Québec, QC, Canada
  • Lucas Dean University of Alberta, Edmonton, AB, Canada
  • Ranjeeta Mallick Ottawa Hospital Research Institute and the University of Ottawa, Ottawa, ON, Canada
  • Luke T. Lavallée Ottawa Hospital Research Institute and the University of Ottawa, Ottawa, ON, Canada
  • Rodney H. Breau Ottawa Hospital Research Institute and the University of Ottawa, Ottawa, ON, Canada

DOI:

https://doi.org/10.5489/cuaj.8506

Keywords:

robotic surgery, minimally invasive surgery, partial nephrectomy, radical nephrectomy, active surveillance, Clinical stage I renal mass

Abstract

INTRODUCTION: Robotic surgery is used in the treatment of kidney tumors. We aimed to determine if robotic access was associated with initial choice of management for patients with a clinical stage I kidney mass.

METHODS: Patients with a clinical stage I kidney mass were identified from the Canadian Kidney Cancer information system (CKCis) cohort. Sites were classified by year and access to robotic surgery. Associations between robotic access and initial management were determined using logistic regression. Univariable and multivariable analyses were performed, adjusting for tumor size and stage, and presented as relative risks (RR) or adjusted RR (aRR) and 95% confidence intervals (CI).

RESULTS: Overall, 4160 patients were included. Among patients treated with surgery, the proportion of partial nephrectomy compared to radical nephrectomy was significantly higher in robotic sites (77.3% for robotic sites vs. 65.9% for non-robotic sites; RR 1.17, 95% CI 1.12–1.23, p<0.0001; aRR 1.12, 95% CI 1.08–1.17, p<0.0001). Patients receiving partial nephrectomy at sites with robotic access were more likely to receive a minimally invasive approach compared to patients at non-robotic sites (61.4% vs. 50.9%, RR 1.21, 95% CI 1.12–1.30; aRR 1.16, 95% CI 1.08–1.25, p<0.0001). The proportion of patients managed by active surveillance was not significantly different between robotic (405, 16.9%) and nonrobotic (258, 14.7%) sites (RR 1.15, 95% CI 0.99–1.32; aRR 0.97, 95% CI 0.84–1.12).

CONCLUSIONS: Access to robotic kidney surgery was associated with increased use of partial nephrectomy and minimally invasive partial nephrectomy. Use of active surveillance was similar at robotic and non-robotic institutions. Limitations of this study include lack of data on perioperative complications and cancer recurrence.

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Published

2023-10-23

How to Cite

Lemire, F., Zhang, M., Anderson, P., Finelli, A., Rendon, R. A. ., Tanguay, S., Bansal, R., Bhindi, B., So, A. I., Pouliot, F., Dean, L., Mallick, R., Lavallée, L. T., & Breau, R. H. . (2023). The impact of robotic surgery access on the management of patients with clinical stage I kidney tumors. Canadian Urological Association Journal, 18(2), 55–60. https://doi.org/10.5489/cuaj.8506

Issue

Vol. 18 No. 2 (2024): CUAJ February

Section

Original Research

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