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World Journal of Urology

, Volume 35, Issue 1, pp 73–80 | Cite as

Robotic and open partial nephrectomy for complex renal tumors: a matched-pair comparison with a long-term follow-up

  • Yubin Wang
  • Jinkai Shao
  • Xin Ma
  • Qingshan Du
  • Huijie Gong
  • Xu ZhangEmail author
Original Article

Abstract

Objectives

To compare the surgical, functional and oncological outcomes of patients undergoing robotic partial nephrectomy (RPN) or open partial nephrectomy (OPN) for moderately or highly complex tumors (RENAL nephrometry score ≥7).

Methods

A retrospective, matched-pair analysis was performed for 380 patients who underwent either RPN (n = 190) or OPN (n = 190) for a complex renal mass in different institutions. Surgical data, pathological variables, complications and functional and oncological outcomes were reviewed.

Results

RPN is associated with less estimated blood loss (EBL) (196.8 vs 240.8 ml; p < 0.001), shorter length of hospital stay (7.8 vs 9.2 days; p < 0.001) and lower rate of postoperative complications (15.8 vs 28.9 %; p = 0.002). Patients undergoing RPN required more direct cost. In multivariable models, surgical approach was the significant predictor for the occurrence of postoperative minor complications and postoperative wound pain. Median follow-up for RPN and OPN was 49 months and 52 months, respectively. The decline of estimated glomerular filtration at the last available follow-up (RPN: 8.7 %; OPN: 10 %) was similar (p = 0.125). The 5-year recurrence-free survival rate was 95.1 % for RPN and 92.7 % for OPN (p = 0.48).

Conclusions

RPN provides acceptable and comparable results in terms of perioperative, functional and oncological outcomes compared to OPN for complex renal tumors with RENAL score ≥7. Moreover, RPN is a less invasive approach with the benefit of shorter length of hospital stay, less EBL and lower rate of postoperative complications.

Keywords

Robotics Partial nephrectomy Renal cell carcinoma RENAL nephrometry score 

Abbreviations

ASA

American Society of Anesthesiologists

BMI

Body mass index

CCI

Charlson comorbidity index

CI

Confidence interval

EBL

Estimated blood loss

eGFR

Estimated glomerular filtration rate

LPN

Laparoscopic partial nephrectomy

MDRD

Modification of diet in renal disease

OPN

Open partial nephrectomy

OR

Odds ratio

PN

Partial nephrectomy

PSM

Positive surgical margins

RFS

Recurrence-free survival

RN

Radical nephrectomy

RPN

Robotic partial nephrectomy

SD

Standard deviation

WIT

Warm ischemia time

Notes

Authors’ contribution

Yubin Wang and Xu Zhang developed the protocol/project; Yubin Wang, Jinkai Shao and Xin Ma contributed to the data collection or management; Qingshan Du and Huijie Gong analyzed the data; Yubin Wang and Qingshan Du wrote and edited the manuscript; Xu Zhang and Jinkai Shao reviewed the manuscript.

Compliance with ethical standard

Conflict of interest

All authors certify that there is no actual or potential conflict of interest in relation to this article.

Ethical standards

The data were obtained from a prospectively maintained database approved by institutional review board and the local ethics committee, and informed consent was collected for all patients.

References

  1. 1.
    Schiffmann J, Bianchi M, Sun M et al (2014) Trends in surgical management of T1 renal cell carcinoma. Curr Urol Rep 15:383–386CrossRefPubMedGoogle Scholar
  2. 2.
    Ljungberg B, Bensalah K, Canfield S et al (2015) EAU guidelines on renal cell carcinoma: 2014 update. Eur Urol 67:913–924CrossRefPubMedGoogle Scholar
  3. 3.
    MacLennan S, Imamura M, Lapitan MC et al (2012) Systematic review of perioperative and quality-of-life outcomes following surgical management of localised renal cancer. Eur Urol 62:1097–1117CrossRefPubMedGoogle Scholar
  4. 4.
    White MA, Haber GP, Autorino R et al (2011) Outcomes of robotic partial nephrectomy for renal masses with nephrometry score of ≥7. Urology 77:809–813CrossRefPubMedGoogle Scholar
  5. 5.
    Komninos C, Shin TY, Tuliao P et al (2014) Robotic partial nephrectomy for completely endophytic renal tumors: complications and functional and oncologic outcomes during a 4-year median period of follow-up. Urology 84:1367–1373CrossRefPubMedGoogle Scholar
  6. 6.
    Volpe A, Garrou D, Amparore D et al (2014) Perioperative and renal functional outcomes of elective robot-assisted partial nephrectomy (RPN) for renal tumours with high surgical complexity. BJU Int 114:903–909CrossRefPubMedGoogle Scholar
  7. 7.
    Borghesi M, Schiavina R, Gan M et al (2013) Expanding utilization of robotic partial nephrectomy for clinical T1b and complex T1a renal masses. World J Urol 31:499–504CrossRefPubMedGoogle Scholar
  8. 8.
    Masson-Lecomte A, Bensalah K, Seringe E et al (2013) A prospective comparison of surgical and pathological outcomes obtained after robot-assisted or pure laparoscopic partial nephrectomy in moderate to complex renal tumours: results from a French multicentre collaborative study. BJU Int 111:256–263CrossRefPubMedGoogle Scholar
  9. 9.
    Long JA, Yakoubi R, Lee B et al (2012) Robotic versus laparoscopic partial nephrectomy for complex tumors: comparison of perioperative outcomes. Eur Urol 61:1257–1262CrossRefPubMedGoogle Scholar
  10. 10.
    Jang HJ, Song W, Suh YS et al (2014) Comparison of perioperative outcomes of robotic versus laparoscopic partial nephrectomy for complex renal tumors (RENAL nephrometry score of 7 or higher). Korean J Urol 55:808–813CrossRefPubMedPubMedCentralGoogle Scholar
  11. 11.
    Wu Z, Li M, Liu B et al (2014) Robotic versus open partial nephrectomy: a systematic review and meta-analysis. PLoS ONE 9:e94878CrossRefPubMedPubMedCentralGoogle Scholar
  12. 12.
    Ficarra V, Minervini A, Antonelli A et al (2014) A multicentre matched-pair analysis comparing robot-assisted versus open partial nephrectomy. BJU Int 113:936–941CrossRefPubMedGoogle Scholar
  13. 13.
    Masson-Lecomte A, Yates DR, Hupertan V et al (2013) A prospective comparison of the pathologic and surgical outcomes obtained after elective treatment of renal cell carcinoma by open or robot-assisted partial nephrectomy. Urol Oncol 31:924–929CrossRefPubMedGoogle Scholar
  14. 14.
    Minervini A, Vittori G, Antonelli A et al (2014) Open versus robotic-assisted partial nephrectomy: a multicenter comparison study of perioperative results and complications. World J Urol 32:287–293CrossRefPubMedGoogle Scholar
  15. 15.
    Simhan J, Smaldone MC, Tsai KJ et al (2012) Perioperative outcomes of robotic and open partial nephrectomy for moderately and highly complex renal lesions. J Urol 187:2000–2004CrossRefPubMedGoogle Scholar
  16. 16.
    Sprenkle PC, Power N, Ghoneim T et al (2012) Comparison of open and minimally invasive partial nephrectomy for renal tumors 4–7 centimeters. Eur Urol 61:593–599CrossRefPubMedGoogle Scholar
  17. 17.
    Patton MW, Salevitz DA, Tyson MD 2nd et al (2016) Robot-assisted partial nephrectomy for complex renal masses. J Robot Surg. 10:27–31CrossRefPubMedGoogle Scholar
  18. 18.
    Kutikov A, Uzzo RG (2009) The RENAL nephrometry score: a comprehensive standardized system for quantitating renal tumor size, location and depth. J Urol 182:844–853CrossRefPubMedGoogle Scholar
  19. 19.
    Dindo D, Demartines N, Clavien PA (2004) Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 240:205–213CrossRefPubMedPubMedCentralGoogle Scholar
  20. 20.
    Levey AS, Bosch JP, Lewis JB et al (1999) A more accurate method to estimate glomerular filtration rate from serum creatinine: a new prediction equation. Modification of Diet in Renal Disease Study Group. Ann Intern Med 16(130):461–470CrossRefGoogle Scholar
  21. 21.
    National Kidney Foundation (2002) K/DOQI clinical practice guidelines for chronic kidney disease: evaluation, classification, and stratification. Am J Kidney Dis 39:S1–S266Google Scholar
  22. 22.
    Ebele JN, Sauter G, Epstein JI et al (2004) Pathology and genetics of tumours of the urinary system and male genital organs. IARC, Lyon, pp 12–43Google Scholar
  23. 23.
    Edge SB, Byrd DR, Compton CC et al (2009) AJCC cancer staging manual, 7th edn. Springer, New York, pp 547–560Google Scholar
  24. 24.
    Choi JE, You JH, Kim DK et al (2015) Comparison of perioperative outcomes between robotic and laparoscopic partial nephrectomy: a systematic review and meta-analysis. Eur Urol 67:891–901CrossRefPubMedGoogle Scholar
  25. 25.
    Froghi S, Ahmed K, Khan MS, Dasgupta P, Challacombe B (2013) Evaluation of robotic and laparoscopic partial nephrectomy for small renal tumours (T1a). BJU Int 112:E322–E333CrossRefPubMedGoogle Scholar
  26. 26.
    Simmons MN, Fergany AF, Campbell SC (2011) Effect of parenchymal volume preservation on kidney function after partial nephrectomy. J Urol 186:405–410CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2016

Authors and Affiliations

  • Yubin Wang
    • 1
  • Jinkai Shao
    • 1
  • Xin Ma
    • 2
  • Qingshan Du
    • 2
  • Huijie Gong
    • 2
  • Xu Zhang
    • 2
    Email author
  1. 1.Department of UrologyShanxi Provincial People’s HospitalTaiyuanChina
  2. 2.Department of UrologyChinese People’s Liberation Army General HospitalBeijingPeople’s Republic of China

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