title: Functional and oncologic outcomes of bilateral open partial nephrectomy versus bilateral laparoscopic partial nephrectomy.
abstract: OBJECTIVE
  This study compared operative data and outcomes in patients undergoing either bilateral open partial nephrectomy (BOPN) or bilateral laparoscopic partial nephrectomy (BLPN) for synchronous bilateral kidney tumors.
  
  
  METHODS
  Patients who had undergone bilateral partial nephrectomy at our institution between 1992 and 2008 were reviewed retrospectively; 114 patients underwent either BOPN or BLPN. Ischemia time, tumor size, and renal function outcomes immediately after each surgery, at an intermediate time point (≤12 months), and at a late time point (>12 months) were compared. Oncologic outcomes were also evaluated using Kaplan-Meier analysis.
  
  
  RESULTS
  BOPN and BLPN were conducted in 92 and 22 patients, respectively. Average tumor size was larger in the BOPN group (4.1 vs 2.7 cm; P=0.001); however, pathologic stage was equivalent (P=0.52). Hospital stay was longer in the BOPN group (5.6 vs 4.0 d; P<0.001). Preoperative estimated glomerular filtration rates (eGFR) in the BOPN and BLPN groups were both ≥60 mL/min/1.73 m(2). Percent decrease in eGFR between the two groups was 38% in the BLPN group and 27% in the BOPN group (P=0.03). Cancer-specific and recurrence-free survival rates were equivalent between groups over a mean follow-up of 5.5 years.
  
  
  CONCLUSIONS
  BOPN and BLPN resulted in equivalent intermediate-term oncologic control. BLPN was associated with a larger percent decrease in eGFR. As ischemia times shorten for contemporary laparoscopic partial nephrectomies, it is expected that functional outcomes will be equivalent.
authors.affiliation: Glickman Urological and Kidney Institute, Cleveland Clinic Foundation, Cleveland, Ohio 44195, USA.
authors.forename: Christina B
authors.initials: CB
authors.lastname: Ching
authors.forename: Jianbo
authors.initials: J
authors.lastname: Li
authors.forename: Inderbir S
authors.initials: IS
authors.lastname: Gill
authors.forename: Matthew N
authors.initials: MN
authors.lastname: Simmons
mesh_terms: D003710:Demography; D005260:Female; D005500:Follow-Up Studies; D005919:Glomerular Filtration Rate; D006801:Humans; D053208:Kaplan-Meier Estimate; D007680:Kidney Neoplasms / Q000473:pathology / Q000503:physiopathology* / Q000601:surgery*; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009392:Nephrectomy / Q000379:methods*; D016896:Treatment Outcome