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World Journal of Urology

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01-10-2015 | Original Article

Perioperative and long-term renal functional outcomes of robotic versus laparoscopic partial nephrectomy: a multicenter matched-pair comparison

Authors: Jeong Ho Kim, Yong Hyun Park, Yong June Kim, Seok Ho Kang, Seok Soo Byun, Cheol Kwak, Sung Hoo Hong

Published in: World Journal of Urology | Issue 10/2015

Abstract

Purpose

We compared perioperative and long-term renal functional outcomes of robot-assisted partial nephrectomy (RAPN) with laparoscopic partial nephrectomy (LPN) for small renal masses.

Materials and methods

A total of 1,032 patients were included for evaluation; propensity score matching was performed to adjust for potential baseline confounders, which resulted in 195 LPNs matched to 195 RAPNs. Patient characteristics including preoperative estimated glomerular filtration rate (eGFR) were investigated, and postoperative results were evaluated.

Results

No significant differences were found between the groups with regard to age, body mass index, sex distribution, preoperative eGFR, or tumor size. The mean follow-up period was 32.4 ± 21.1 months for LPN patients versus 31.1 ± 24.5 months for RAPN patients (p = 0.589). Operative time (p < 0.001) and warm ischemic time (p < 0.001) were significantly shorter in the RAPN group. No significant differences were observed in the overall change in eGFR (p = 0.768) or positive surgical margin rate (p = 0.653). A multivariate analysis showed that preoperative eGFR and hypertension significantly influenced the risk of stage 3 and 4 chronic kidney disease. A significant deterioration in renal function occurred 3 months after surgery. However, renal function increased gradually after the nadir eGFR was reached. The amount of renal functional recovery was higher in the RAPN group.

Conclusions

Operative parameters for RAPN appear to be less affected by tumor complexity. Functional outcomes of RAPN were superior to those of LPN. Renal function recovered continuously during the 60-month follow-up period after partial nephrectomy.

Riggs SB, Larochelle JC, Belldegrun AS (2008) Partial nephrectomy: a contemporary review regarding outcomes and different techniques. Cancer J 14:302–307CrossRefPubMed

Simmons MN, Weight CJ, Gill IS (2009) Laparoscopic radical versus partial nephrectomy for tumors >4 cm: intermediate-term oncologic and functional outcomes. Urology 73:1077–1082CrossRefPubMed

Deklaj T, Lifshitz DA, Shikanov SA, Katz MH, Zorn KC, Shalhav AL (2010) Laparoscopic radical versus laparoscopic partial nephrectomy for clinical T1bN0M0 renal tumors: comparison of perioperative, pathological, and functional outcomes. J Endourol 24:1603–1607CrossRefPubMed

Gill IS, Kavoussi LR, Lane BR, Blute ML, Babineau D, Colombo JR Jr, Frank I, Permpongkosol A, Weight CJ, Kaouk JH, Kattan MVV, Novick AC (2007) Comparison of 1,800 laparoscopic and open partial nephrectomies for single renal tumors. J Urol 178:41–46CrossRefPubMed

Kim FJ, Rha KH, Hernandez F, Jarrett TW, Pinto PA, Kavoussi LR (2003) Laparoscopic radical versus partial nephrectomy: assessment of complications. J Urol 170:408–411CrossRefPubMed

Rogers CG, Patard JJ (2009) Open to debate. The motion: robotic partial nephrectomy is better than open partial nephrectomy. Eur Urol 56:568–570CrossRefPubMed

Benway BM, Bhayani SB, Rogers CG, Dulabon LM, Patel MN, Lipkin M, Wang AJ, Stifelman MD (2009) Robot assisted partial nephrectomy versus laparoscopic partial nephrectomy for renal tumors: a multi-institutional analysis of perioperative outcomes. J Urol 182:866–872CrossRefPubMed

Aboumarzouk OM, Stein RJ, Eyraud R, Haber GP, Chlosta PL, Somani BK, Kaouk JH (2012) Robotic versus laparoscopic partial nephrectomy: a systematic review and meta-analysis. Eur Urol 62:1023–1033CrossRefPubMed

Levey AS, Bosch JP, Lewis JB, Greene T, Rogers N, Roth D (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 130:461–470CrossRefPubMed

10.

Finley DS, Lee DI, Eichel L, Uribe CA, McDougall EM, Clayman RV (2005) Fibrin glue-oxidized cellulose sandwich for laparoscopic wedge resection of small renal lesions. J Urol 173:1477–1481CrossRefPubMed

11.

Levey AS, Coresh J, Balk E, Kausz AT, Levin A, Steffes MW, Hogg RJ, Perrone RD, Lau J, Eknoyan G (2003) National kidney foundation practice guidelines for chronic kidney disease: evaluation, classification, and stratification. Ann Intern Med 139:137–147CrossRefPubMed

12.

Froghi S, Ahmed K, Khan MS, Dasgupta P, Challacomb B (2013) Evaluation of robotic and laparoscopic partial nephrectomy for small renal tumours (T1a). BJU Int 112:E322–E333CrossRefPubMed

13.

Wu Z, Li M, Song S, Ye H, Yang Q, Liu B, Cai C, Yang B, Xiao L, Chen Q, Lü C, Gao X, Xu C, Gao X, Hou J, Wang L, Sun Y (2014) Propensity-score matched analysis comparing robot-assisted with laparoscopic partial nephrectomy. BJU Int. doi:10.1111/bju.12774

14.

Khalifeh A, Autorino R, Hillyer SP, Laydner H, Eyraud R, Panumatrassamee K, Long JA, Kouk JH (2013) Comparative outcomes and assessment of trifecta in 500 robotic and laparoscopic partial nephrectomy cases: a single surgeon experience. J Urol 189:1236–1242CrossRefPubMed

15.

Wang AJ, Bhayani SB (2009) Robotic partial nephrectomy versus laparoscopic partial nephrectomy for renal cell carcinoma: single-surgeon analysis of >100 consecutive procedures. Urology 73:306–310CrossRefPubMed

16.

Choi JD, Park JW, Lee HW, Lee DG, Jeong BC, Jeon SS, Lee HM, Choi HY, Seo SI (2013) A comparison of surgical and functional outcomes of robot-assisted versus pure laparoscopic partial nephrectomy. JSLS 17:292–299PubMedCentralCrossRefPubMed

17.

Ellison JS, Montgomery JS, Wolf JS Jr, Hafez KS, Miller DC, Weizer AZ (2012) A matched comparison of perioperative outcomes of a single laparoscopic surgeon versus a multisurgeon robot-assisted cohort for partial nephrectomy. J Urol 188:45–50CrossRefPubMed

18.

Park SW, Jung SG, Lee W, Chung MK (2010) Changes in renal function after nephron-sparing surgery in patients with a normal contralateral kidney. Int J Urol 17:457–461CrossRefPubMed

19.

Huang WC, Levey AS, Serio AM, Snyder M, Vickers AJ, Raj GV, Scardino PT, Russo P (2006) Chronic kidney disease after nephrectomy in patients with renal cortical tumours: a retrospective cohort study. Lancet Oncol 7:735–740PubMedCentralCrossRefPubMed

20.

Lucas SM, Stern JM, Adibi M, Zeltser IS, Cadeddu JA, Raj GV (2008) Renal function outcomes in patients treated for renal masses smaller than 4 cm by ablative and extirpative techniques. J Urol 179:75–79CrossRefPubMed

21.

Becker F, Van Poppel H, Hakenberg OW, Stief C, Gill I, Guazzoni G, Montorsi F, Russo P, Stöckle M (2009) Assessing the impact of ischaemia time during partial nephrectomy. Eur Urol 56:625–634CrossRefPubMed

22.

Thompson RH, Lane BR, Lohse CM, Leibovich BC, Fergany A, Frank I, Gill IS, Blute ML, Campbell SC (2010) Every minute counts when the renal hilum is clamped during partial nephrectomy. Eur Urol 58:340–345CrossRefPubMed

23.

Chan AA, Wood CG, Caicedo J, Munsell MF, Matin SF (2010) Predictors of unilateral renal function after open and laparoscopic partial nephrectomy. Urology 75:295–302CrossRefPubMed

24.

Porpiglia F, Renard J, Billia M, Musso F, Volpe A, Burruni R, Terrone C, Colla L, Piccoli G, Podio V, Scarpa RM (2007) Is renal warm ischemia over 30 minutes during laparoscopic partial nephrectomy possible? One-year results of a prospective study. Eur Urol 52:1170–1178CrossRefPubMed

25.

Song C, Park S, Jeong IG, Hong JH, Park HK, Kim CS, Ahn H (2011) Followup of unilateral renal function after laparoscopic partial nephrectomy. J Urol 186:53–58CrossRefPubMed

26.

Song C, Bang JK, Park HK, Ahn H (2009) Factors influencing renal function reduction after partial nephrectomy. J Urol 181:48–53CrossRefPubMed

27.

Wesson LG (1989) Compensatory growth and other growth responses of the kidney. Nephron 51:149–184CrossRefPubMed

28.

Shirasaki Y, Tsushima T, Saika T, Nasu Y, Kumon H (2004) Kidney function after nephrectomy for renal cell carcinoma. Urology 64:43–47CrossRefPubMed

29.

Anderson RG, Bueschen AJ, Lloyd LK, Dubovsky EV, Burns JR (1991) Short-term and long-term changes in renal function after donor nephrectomy. J Urol 145:11–13PubMed

Title: Perioperative and long-term renal functional outcomes of robotic versus laparoscopic partial nephrectomy: a multicenter matched-pair comparison
Authors: Jeong Ho Kim
Yong Hyun Park
Yong June Kim
Seok Ho Kang
Seok Soo Byun
Cheol Kwak
Sung Hoo Hong
Publication date: 01-10-2015
Publisher: Springer Berlin Heidelberg
Published in: World Journal of Urology / Issue 10/2015
Print ISSN: 0724-4983
Electronic ISSN: 1433-8726
DOI: https://doi.org/10.1007/s00345-015-1488-5

At a glance: The STEP trials

Springer Medicine

Perioperative and long-term renal functional outcomes of robotic versus laparoscopic partial nephrectomy: a multicenter matched-pair comparison

Abstract

Purpose

Materials and methods

Results

Conclusions

At a glance: The STEP trials

Springer Medicine

Abstract

Purpose

Materials and methods

Results

Conclusions

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