Session: MP58: Kidney Cancer: Localized: Surgical Therapy III
MP58-18: Robotic partial nephrectomy is associated with a significantly decreased rate of postoperative pseudoaneurysm as compared to open and laparoscopic partial nephrectomy
Introduction: Partial nephrectomy is the surgical treatment of choice for T1 renal tumors. Renal artery pseudoaneurysm is a rare but life threatening complication. The present study reviews the incidence, management and outcomes of this complication in a large series. Methods: Between 2012-2022, 785 patients underwent partial nephrectomy at our institution. 398 patients underwent Robotic-assisted partial nephrectomy (RAPN), 122 patients underwent laparoscopic partial nephrectomy (LPN) and 265 patients underwent open partial nephrectomy (OPN). Clinical files and imaging studies were analyzed including demographic data, tumor size and location, type of surgery, clinical presentation, treatment modality and outcomes. Results: Seventeen patients (2.1%) were diagnosed with pseudoaneurysm following partial nephrectomy. 4 patients (1%) following RAPN, 4 patients (3.3%) following LPN, 9 patients (3.4%) following OPN (P_VALUE=0.049). The presenting symptoms included massive hematuria (100%), Hemorrhagic shock (5.8%) and clot retention (23%). Symptoms onset was late at a median time of 12 days postoperatively. The median diameter of the operated tumors was 43 mm. Renal score for 11.7% of the patients was 5, for 41% of the patients was 7 and 8, for 6% renal score was 10. Seven tumors were central (41.1%). Selective embolization of the bleeding vessel was performed resulting in immediate interruption of bleeding in 94%, while in 1 patient (6%) a second embolization was necessary. No patient underwent A nephrectomy to stop the bleeding. Creatinine levels as a surrogate of kidney function in one year follow - up were not significantly higher. Conclusions: RAPN is associated with a significantly decreased rate of postoperative pseudoaneurysm as compared to open and laparoscopic partial nephrectomy.Emergency angiographic selective embolization is an efficient treatment with a high success rate. SOURCE OF Funding: none
