title: Elective laparoscopic partial nephrectomy in patients with tumors >4 cm.
abstract: OBJECTIVE
  To assess the perioperative outcomes of elective laparoscopic partial nephrectomy to treat renal tumors in patients with tumor burdens > 4 cm compared with those with tumor burdens of < or = 4 cm.
  
  
  METHODS
  A retrospective review of medical records was performed for all patients who had undergone laparoscopic partial nephrectomy for renal tumors from January 2000 to March 2005. The preoperative risk factors (ie, sex, age, American Society for Anesthesiologists score), perioperative course (ie, operative time, estimated blood loss, warm ischemia time, intraoperative and postoperative complications, transfusion rate, intraoperative biopsy of surgical margins, length of hospitalization), and pathologic outcomes (ie, tumor stage, type, and grade) were collected and compared between the patients in the 2 cohorts.
  
  
  RESULTS
  Patients with larger tumors had significantly more complications (37.0% vs 21.8%, P = .039) and a significantly longer hospitalization (4.1 vs 3.0 days, P = .026). For those with malignant tumors > 4 cm compared with those with malignant tumors of < or = 4 cm, the complication rate was 33.3% and 11.6% (P = 0.006) and the length of hospitalization was 4.5 and 3.2 days (P = .055), respectively. No other differences were noted between the 2 groups stratified by tumor size.
  
  
  CONCLUSIONS
  Laparoscopic partial nephrectomy is an oncologically feasible option for tumor burdens > 4 cm in the greatest dimension to provide a nephron-sparing option for patients in whom individually selected lesions can be isolated.
authors.affiliation: Arthur Smith Institute for Urology, North Shore-Long Island Jewish Health System, Long Island, New York 11030, USA.
authors.forename: Soroush
authors.initials: S
authors.lastname: Rais-Bahrami
authors.forename: Frederico R
authors.initials: FR
authors.lastname: Romero
authors.forename: Guilherme C
authors.initials: GC
authors.lastname: Lima
authors.forename: Sahar
authors.initials: S
authors.lastname: Kohanim
authors.forename: Sompol
authors.initials: S
authors.lastname: Permpongkosol
authors.forename: Bruce J
authors.initials: BJ
authors.lastname: Trock
authors.forename: Thomas W
authors.initials: TW
authors.lastname: Jarrett
authors.forename: Louis R
authors.initials: LR
authors.lastname: Kavoussi
mesh_terms: D000367:Age Factors; D000368:Aged; D005260:Female; D006801:Humans; D007680:Kidney Neoplasms / Q000473:pathology / Q000601:surgery*; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D008495:Medical Oncology / Q000379:methods*; D008875:Middle Aged; D009392:Nephrectomy / Q000379:methods*; D011183:Postoperative Complications; D012189:Retrospective Studies; D016896:Treatment Outcome; D014572:Urology / Q000379:methods*