988 OPEN, LAPAROSCOPIC, AND ROBOTIC PARTIAL NEPHRECTOMY: A SINGLE INSTITUTION ANALYSIS WITH PERIOPERATIVE AND ONCOLOGIC OUTCOMES (2010)

You have accessJournal of UrologyKidney Cancer: Localized II1 Apr 2010988 OPEN, LAPAROSCOPIC, AND ROBOTIC PARTIAL NEPHRECTOMY: A SINGLE INSTITUTION ANALYSIS WITH PERIOPERATIVE AND ONCOLOGIC OUTCOMES Jay Simhan, Robert Uzzo, David Chen, Stephen Boorjian, Benjamin Scoll, and Rosalia Viterbo Jay SimhanJay Simhan More articles by this author , Robert UzzoRobert Uzzo More articles by this author , David ChenDavid Chen More articles by this author , Stephen BoorjianStephen Boorjian More articles by this author , Benjamin ScollBenjamin Scoll More articles by this author , and Rosalia ViterboRosalia Viterbo More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2010.02.1957AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Nephron sparing surgery (NSS) is a well established modality to treat patients with small renal masses. With advances in technology and experience in minimally invasive surgery, urologists have more options when approaching patients with renal masses. There are clear advantages to laparoscopy, but it is recognized to be more technically challenging. We compared outcomes of open, laparoscopic, and robotic partial nephrectomy with intermediate term follow-up. METHODS We prospectively queried our institutional Kidney Cancer Database for the most recent 50 consecutive patients, in each group, who underwent open partial nephrectomy (OPN), laparoscopic partial nephrectomy (LPN), or robot assisted partial nephrectomy (RPN). Perioperative data including, clinicopathologic variables, complications and oncologic outcomes were reviewed and statistically analyzed. RESULTS Comparison of operative data revealed a significant difference in estimated blood loss (274 mL vs. 91 mL vs. 117 mL) and length of stay (5.9 vs. 4.6 vs. 3.2 days) for the OPN, LPN, and RPN groups respectively. Mean patient age, creatinine, and overall operative time were not significantly different. Major/minor complication rates for all three groups were 12%/10% (OPN), 4%/6% (LPN), and 2%/2% (RPN). Mean tumor size for the OPN, LPN, and RPN groups was 2.5 cm, 2.0 cm, and 2.8 cm respectively. Pathology demonstrated renal cell carcinoma in 92%, 70%, and 82% while microscopic positive margins on final pathology were seen in 2%, 12%, and 4% of the OPN, LPN, and RPN specimens respectively. Median follow up for OPN, LPN, and RPN were 21 months, 40 months, and 12 months respectively. There were no cancer recurrences in the LPN and RPN groups, but 2 patients with local recurrence in the OPN arm were detected with one patient undergoing cryotherapy after recurrence was diagnosed. CONCLUSIONS LPN and RPN have several similar operative characteristics and outcomes compared to OPN. However, in the hands of experienced laparoscopic and robotic surgeons, LPN and RPN appear to be associated with decreased length of stay and estimated blood loss. Although the robotic approach to NSS may be technically challenging, equivalent, if not improved, perioperative complication rates and oncologic outcomes are demonstrated when compared to OPN and LPN. Larger comparative studies with longer follow up and standardized reporting of tumor difficulty are needed to further evaluate the optimal role for each approach to NSS. Philadelphia, PA© 2010 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 183Issue 4SApril 2010Page: e384-e385 Advertisement Copyright & Permissions© 2010 by American Urological Association Education and Research, Inc.MetricsAuthor Information Jay Simhan More articles by this author Robert Uzzo More articles by this author David Chen More articles by this author Stephen Boorjian More articles by this author Benjamin Scoll More articles by this author Rosalia Viterbo More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...