Abstract
Introduction
Kidney cancer remains a significant public health issue, mainly treated by surgery for localized tumors. RAPN is increasingly adopted due to its nephron-sparing advantage, yet optimal management of the renal resection bed remains controversial. Various techniques including parenchymal and/or capsular sutures or sutureless approaches, with or without adjunctive hemostatic agents (HA), are used, but their comparative safety and efficacy are not well established.Materials and methods
This retrospective study analyzed data from 5,250 patients who underwent first RAPN in 26 centres, extracted from national UroCCR database. Patients were categorized into eight groups based on resection bed management techniques, with the main groups being double-layer sutures (DLS) and parenchymal sutures, with or without HA. Postoperative complications were classified using the Clavien-Dindo system. Multivariate logistic regression was performed adjusting for key confounders including age, sex, BMI, ASA score, RENAL-score, and preoperative creatinine. Secondary outcomes included length of hospital stay and comparison of HA use within suture and sutureless groups.Results
Intraoperative complications were rare (3.9%). Postoperative complications occurred in 19.1% of patients, with 3.1% experiencing severe complications (≥ grade 3). The "Sutureless without HA" group had a significantly higher rate of perioperative transfusions in multivariate analysis (17.8% vs. 6.8%; adjusted OR 3.3), although this did not translate into increased reinterventions or perirenal hematomas. No significant differences were found between groups regarding infectious or length of stay. Vascular complications were lower in "DLS with HA". The use of HA in sutureless groups was associated with shorter operative times and reduced transfusion rates, and no difference was observed in suture groups.Conclusion
In this large, multicenter cohort, various hemostatic techniques during RAPN showed overall comparable safety profiles, except for a higher transfusion rate associated with sutureless without HA approaches, and a protective effect on vascular complications of DLS with HA.