Surgical experience and functional outcomes after laparoscopic and robot-assisted partial nephrectomy: Results from a multi-institutional collaboration (2024)

Introduction & Objectives: In patients treated with partial nephrectomy, prior evidence showed that peri-operative outcomes such ascomplications and ischemia time improved as a function of surgical experience of the surgeon, but data on functional outcomes after surgeryis still scarce.Materials & Methods: We retrospectively analyzed data of 4,011 patients with a single, unilateral cT1a-b renal mass treated withlaparoscopic or robot-assisted partial nephrectomy by 119 surgeons at 22 participating institutions between 1997 and 2022. Multivariablemodels investigated the association between surgical experience (number of prior operations) and acute kidney injury (AKI) and recovery of atleast 90% of baseline estimated glomerular filtration rate (eGFR) 1 yr after partial nephrectomy.Results: A total of 753 (19%) and 3258 (81%) patients underwent laparoscopic and robot-assisted partial nephrectomy, respectively. Overall,37 (31%) and 55 (46%) surgeons contributed only to laparoscopic and robotic learning curves, whereas 27 (23%) contributed to bothapproaches. In the laparoscopic group, 8% and 55% of patients developed AKI and recovered at least 90% of their baseline eGFR,respectively. After adjusting for confounders, we did not find evidence of an association between surgical experience and AKI afterlaparoscopic partial nephrectomy (p=0.6). Similar results were found when 1-year renal function was the outcome of interest (p=0.5). Amongpatients who underwent robot-assisted partial nephrectomy, AKI occurred in 11% of patients, whereas 54% recovered at least 90% of theirbaseline eGFR. On multivariable analyses, the relationship between surgical experience and AKI after surgery was not statistically significant(p=0.2), with similar results when the outcome of interest was renal function one year after surgery (p=0.9; Figure 1).Conclusions: In patients treated with laparoscopic or robot-assisted partial nephrectomy, our data suggests that surgical experience of theoperating surgeon might not be a key determinant of functional recovery after surgery. This raises questions about the use of serum markersto assess functional recovery in patients with two kidneys, and opens the discussion on what are the key steps of the procedure that allowedsurgeons to achieve optimal outcomes since their initial cases. analyzed separately.

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