Background Intraoperative kidney tumor rupture (TR) can occur during robot-assisted partial nephrectomy (RAPN) in daily clinical practice, but there are no solid guidelines on the management and implications of it. The purpose of the study was to investigate the impact of TR on tumor recurrences, what a surgeon should do if this adverse event occurs, and how to avoid it. Patients and methods We retrospectively analyzed the first 100 patients who underwent RAPN at University Medical Centre Ljubljana, between 2018 and 2021. Patients were stratified into 2 groups (TR and no-TR) and were compared according to patient, tumor, pathologic, perioperative and postoperative characteristics and tumor recurrences, using the Mann-Whitney U test and chi-squared test. Results Of the 100 patients, 14 had TR (14%); this occurred in tumors with higher RENAL nephrometry scores (P = 0.028) and mostly with papillary renal cell carcinomas (P = 0.043). Median warm ischemia time was longer for the TR group (22 vs. 15 min, P = 0.026). In terms of studied outcomes, there were no cases of local or distant recurrence after a median observation time of 39 months (interquartile range, 31–47 months) in both groups. We observed positive surgical margins on the final oncologic report in one case in the no-TR group. Conclusions Tumor rupture during RAPN seems to be of no mid-term oncologic importance. According to presented results, we would recommend surgeons to proceed with tumor resection if this event occurs and abstain from conversion to radical nephrectomy or open partial nephrectomy. However, more similar cases should be studied to make more solid conclusions.

中文翻译：

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机器人辅助肾部分切除术中肿瘤破裂对中期肿瘤复发有影响吗？

背景 在日常临床实践中，机器人辅助肾部分切除术（RAPN）期间可能会发生术中肾肿瘤破裂（TR），但目前还没有关于其处理和影响的可靠指南。该研究的目的是调查 TR 对肿瘤复发的影响、如果发生这种不良事件外科医生应该做什么以及如何避免。患者和方法 我们回顾性分析了 2018 年至 2021 年间在卢布尔雅那大学医学中心接受 RAPN 的前 100 名患者。患者被分为 2 组（TR 组和无 TR 组），并根据患者、肿瘤、病理、围手术期和治疗情况进行比较。术后特征和肿瘤复发，使用Mann-Whitney U 检验和卡方检验。结果 100例患者中，14例出现TR（14%）；这种情况发生在肾肾测量评分较高的肿瘤中（P = 0.028），并且大多数为乳头状肾细胞癌（P = 0.043）。TR 组的中位热缺血时间较长（22与15分钟，磷= 0.026）。就研究结果而言，两组中位观察时间为 39 个月（四分位距，31-47 个月）后均未出现局部或远处复发病例。我们在非 TR 组的一例病例中观察到最终肿瘤学报告中手术切缘呈阳性。结论 RAPN 期间的肿瘤破裂似乎不具有中期肿瘤学重要性。根据目前的结果，如果发生这种情况，我们建议外科医生进行肿瘤切除术，并避免转为根治性肾切除术或开放性肾部分切除术。但是，还应该研究更多类似的案例，才能得出更可靠的结论。