Robot-assisted partial nephrectomy in patients with multiple ipsilateral renal tumors: single-centre experience

Aim: This study aimed to report the perioperative outcomes of off-clamp robot-assisted partial nephrectomy (RAPN) for multiple ipsilateral renal tumours at our Institution. Methods: Data of consecutive patients affected by multiple ipsilateral renal tumours managed by RAPN between September 2018 and June 2023 were retrospectively analysed. Perioperative and post-operative data were collected. Eventual intra- and post-operative complications with or without readmissions (occurred within 30 days) were recorded and classified according to Clavien-Dindo system. Final pathology examination of excised tumours was performed. Results: Twelve patients were included in the analysis. Median tumour size was 34 mm and median R.E.N.A.L. [(R)adius (tumour size as maximal diameter), (E)xophytic/endophytic properties of the tumour, (N)earness of tumour deepest portion to the collecting system or sinus, (A)nterior (a)/posterior (p) descriptor and the (L)ocation relative to the polar line] score was 6. Median console time was 134 min. An off-clamp approach with pure enucleation was possible in 20 out of 28 lesions (71.4%). Median estimated blood loss was 200 mL. No differences were observed in renal function both at discharge and after 30 days, with respect to baseline. No intraoperative complications were recorded. Post-operative complications occurred in two patients, both classified as Clavien-Dindo grade 2. Positive surgical margins were reported in one case (4.5%). No local recurrence or metastasis were diagnosed within a median follow-up of six months. Conclusion: Our case series showed the feasibility of off-clamp RAPN in patients with multiple ipsilateral renal tumours in experienced hands. Further studies with larger sample size and longer follow-up are warranted to better define the optimal management strategy in such an uncommon scenario.