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Nephrometry score matched robotic vs. laparoscopic vs. open partial nephrectomy

  • Pooya Banapour
  • George A. Abdelsayed
  • Zoe Bider-Canfield
  • Peter A. Elliott
  • Patrick S. Kilday
  • Gary W. Chien
Original Article

Abstract

To compare perioperative outcomes in the three most common partial nephrectomy modalities: robotic (RPN), laparoscopic (LPN), and open (OPN), matched for nephrometry scores. Patients aged 16–85 who underwent RPN, LPN, or OPN from 2007 to 2014 for localized renal carcinoma within our healthcare system were enrolled. Age, sex, body mass index, and Charlson Comorbidity Index (CCI) as well as perioperative outcomes of estimated blood loss (EBL), length of hospital stay (LOS), ischemia time (IT), change in eGFR, positive margin rate, operative time (OT), and emergency room visit rates were compared between RPN, LPN, and OPN using the R.E.N.A.L nephrometry score. A total of 862 patients underwent partial nephrectomy (523 LPN, 176 OPN, and 163 RPN). Patients who underwent OPN were significantly older, and had higher nephrometry scores and CCI. When matched for nephrometry scores, minimally invasive (LPN and RPN) compared to OPN had lower EBL (< 0.0001), shorter LOS (< 0.0001), shorter IT (< 0.001), and less change in eGFR (< 0.001), particularly in nephrometry scores higher than 8 (0.0099). Comparing RPN with LPN, RPN had significantly shorter OT in all nephrometry scores (< 0.001); shorter IT and LOS in nephrometry scores higher than 7. Our study suggests that minimally invasive partial nephrectomy may have superior outcomes to OPN when matched by nephrometry scores, particularly at higher scores and for RPN. This finding may contribute to a surgeon’s decision in the approach to partial nephrectomy.

Keywords

Laparoscopy Nephrectomy Renal cancer Robotic Surgical procedures 

Abbreviations

BMI

Body mass index

CCI

Charlson Comorbidity Index

CT

Computed tomography

CPT

Current Procedural Terminology

EMR

Electronic medical record

EBL

Estimated blood loss

eGFR

Estimated glomerular filtration rate

IT

Ischemia time

KPSC

Kaiser Permanente Southern California

LPN

Laparoscopic partial nephrectomy

LOS

Length of hospital stay

MRI

Magnetic resonance imaging

MIPN

Minimally invasive partial nephrectomy

OPN

Open partial nephrectomy

OT

Operative time

RPN

Robotic-assisted partial nephrectomy

ER

Emergency room

Notes

Compliance with ethical standards

Conflict of interest

Pooya Banapour, George A. Abdelsayed, Zoe Bider-Canfield, Peter A. Elliott, Patrick S. Kilday, and Gary W. Chien declare that they have no conflict of interest.

Informed consent

All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2000 (5). Informed consent was obtained from all patients for being included in the study.

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Copyright information

© Springer-Verlag London Ltd., part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of UrologyKaiser Permanente Los Angeles Medical CenterLos AngelesUSA
  2. 2.Department of Research & EvaluationKaiser PermanentePasadenaUSA

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