1652 1097 ROBOTIC, LAPAROSCOPIC AND OPEN PARTIAL NEPHRECTOMIES: COMPARISON OF SURGICAL OUTCOMES AT A SINGLE INSTITUTION

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You have accessJournal of UrologyKidney Cancer: Localized (IV)1 Apr 20131652 1097 ROBOTIC, LAPAROSCOPIC AND OPEN PARTIAL NEPHRECTOMIES: COMPARISON OF SURGICAL OUTCOMES AT A SINGLE INSTITUTION Humberto Laydner, Ahmad Kassab, Ali Khalifeh, Riccardo Autorino, Robert Stein, Georges-Pascal Haber, Matthew Simmons, Amr Fergany, and Jihad Kaouk Humberto LaydnerHumberto Laydner Cleveland, OH , Ahmad KassabAhmad Kassab Cleveland, OH , Ali KhalifehAli Khalifeh Cleveland, OH , Riccardo AutorinoRiccardo Autorino Cleveland, OH , Robert SteinRobert Stein Cleveland, OH , Georges-Pascal HaberGeorges-Pascal Haber Cleveland, OH , Matthew SimmonsMatthew Simmons Cleveland, OH , Amr FerganyAmr Fergany Cleveland, OH , and Jihad KaoukJihad Kaouk Cleveland, OH View All Author Informationhttps://doi.org/10.1016/j.juro.2013.02.3118AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Robotic partial nephrectomy(RPN) was first reported in 2004. Large studies comparing RPN to established techniques are important to better define the role of RPN. We compare outcomes of RPN, laparoscopic(LPN) and open partial nephrectomy(OPN) approaches. METHODS We retrospectively reviewed an IRB-approved database for 1097 patients who underwent PN at our institution from March 2002 to May 2012. Renal function was assessed by the estimated glomerular filtration rate(eGFR). RENAL-nephrometry score(RNS) was used to evaluate tumor complexity. Continuous variables were analyzed with Kruskal-Wallis and Wilcoxon tests, and categorical variables were analyzed with Chi-square and Fisher's exact test. RESULTS We identified 554 RPN, 339 LPN, and 204 OPN. RPN and LPN groups had similar demographics. OPN had more complex tumors(median RNS 8) than RPN(7;p=0.002) and LPN(6;p <0.001), as well as lower preoperative median eGFR(77ml/min/1.73 m2) than LPN(88;p<0.001) and RPN(85;p=0.009). OPN had more blood loss(300mL) than RPN(230;p=0.002) and LPN(250;p=0.004). Blood transfusion was not significantly different among the groups (p=0.19). Conversion rate to OPN was significantly higher for LPN than RPN(2.6%vs.0;p <0.001). Median WIT was similar for RPN and OPN groups(20 and 21min; p=0.9), and both were significantly shorter than LPN(26 min;p <0.001). Complications were comparable between RPN and OPN(24% and 25%;p=0.4) and both were lower than LPN(30%;p=0.002). LPN had significant higher rate of Clavien≥3(8.5%) than RPN(2.5%;p=0.002) and OPN(2.4%;p=0.002). OPN had longer hospital stay (p <0.001). RPN had lower positive margin rate(2.5%) than LPN(5.6%;p <0.001) and OPN(5.4%;p <0.001). LPN group had longer median follow up(28 months vs. 6.3 for RPN and 6.2 for OPN;p <0.001). There were no differences in operative time(p=0.41) and changes in renal function(p=0.53). The main limitations are the retrospective nature of our study and shorter follow up of the RPN and OPN groups. CONCLUSIONS Despite more complex tumors, RPN had superior surgical outcomes compared to LPN in the short term evaluation. Even with some difference in demographic characteristics, RPN and OPN had comparable surgical outcomes. RPN afforded least positive margins and shortest hospital stay. Table 1. Demographics, Outcomes, and Pathology RPN (n = 554) LPN (n = 339) OPN (n = 204) p†; DEMOGRAPHICS Age (years) 59 (18 - 88) 60 (21 - 90) 62 (15 - 90) 0.30 BMI (Kg/m2) 29 (22 - 63) 28 (17 - 75) 29 (18 - 54) 0.29 ASA score 3 (1 - 4) 2 (1 - 4) 3 (1 - 4) 0.004 Tumor size (cm) 2.8 (1 - 12) 2.4 (0.5 - 11) 3.9 (1 - 16) < 0.001 RNS 7 (4 - 12) 6 (4 - 10) 8 (4 - 12) < 0.001 Preoperative eGFR 85 (20 - 163) 88 (20 - 176) 77 (24 - 158) < 0.001 OUTCOMES EBL (mL) 230 (5 - 2500) 250 (25 - 6000) 300 (50 - 5000) 0.003 Blood transfusion n (%) Intraoperative 12 (2.1) 6 (1.8) 8 (3.9) 0.84 Postoperative 39 (7) 31 (9.1) 13 (6.4) 0.19 WIT (min) 20 (0 - 90) 26 (0 - 55) 21 (7 - 60) < 0.001 Operative time (min) 180 (90 - 540) 180 (71 - 330) 195 (81 - 545) 0.41 % Preserved