Details

Autor(en) / Beteiligte

• Brandao, Luis Felipe
• Zargar, Homayoun
• Autorino, Riccardo
• Akca, Oktay
• Laydner, Humberto
• Samarasekera, Dinesh
• Krishnan, Jayram
• Haber, Georges-Pascal
• Stein, Robert J
• Kaouk, Jihad H

Titel

Robot-assisted Partial Nephrectomy for ≥7 cm Renal Masses: A Comparative Outcome Analysis

Ist Teil von

• Urology (Ridgewood, N.J.), 2014-09, Vol.84 (3), p.602-608

Ort / Verlag

United States: Elsevier Inc

Erscheinungsjahr

2014

Quelle

MEDLINE

Beschreibungen/Notizen

• Objective To present our robotic partial nephrectomy (RPN) experience for renal masses ≥7 cm and compare the surgical outcomes in this cohort with those obtained for small (≤4 cm) renal masses. Materials and Methods We retrospectively reviewed our institutional review board–approved RPN database and identified patients undergoing RPN for tumors ≥7 cm. Surgical technique, renal function, oncologic, and pathologic data were analyzed and compared with the RPN for renal masses ≤4 cm. Results Overall, 441 patients were identified for the purpose of this study, including 29 cases and 412 controls. Median operative time (200 vs 180 min; P  = .005), warm ischemia time (26.5 vs 19 min; P  <.001), and estimated blood loss (250 mL [353] vs 150 mL [150]; P  <.001) were significantly lower in the control group. Postoperative complications were significantly higher in the case group (37.9% vs 15.8%; P  = .005). However, the percentages of major complications (Clavien grade ≥III) were comparable (18.2% vs 17%; P  = .57 for cases and controls respectively). Postoperative blood transfusion was higher for larger tumor group (24.1% vs 4.1%; P  <.001). Positive margins were similar between groups (5.9% vs 3.3%; P  = .45 for cases and controls respectively). There was no difference in estimated glomerular filtration rate decline between the two groups (12.2% vs 15.8% decline; P  = .98). Conclusion RPN represents a feasible and safe nephron-sparing surgery approach for highly selected (mostly exophytic growth pattern, polar location, and likelihood of benign histology) renal masses ≥7 cm in diameter.