title: Surgical and oncologic outcomes of laparoscopic partial nephrectomy: a Japanese multi-institutional study of 1375 patients.
abstract: OBJECTIVE
  Despite clear trends toward minimally invasive surgery, information about laparoscopic partial nephrectomy (LPN) in Japan is sparse. We conducted a retrospective survey to clarify time trends for LPN and analyze surgical and oncologic outcomes.
  
  
  METHODS
  A nationwide survey was performed. Between 1998 and 2008, 1375 patients underwent LPN at 54 institutions. Complications, patterns of tumor recurrence, and recurrence-free survival were analyzed.
  
  
  RESULTS
  Renal pedicle clamping was used in 1031 (75%) cases, and renal cooling was performed in 64%. Median warm/cold ischemic time was 37/53 minutes. Median tumor size was 2.26 cm (interquartile range 1.6 to 2.7). Multivariate analysis identified total operative time, operative blood loss, and surgical margin status as independently associated with high grade (grade 3-5) urologic and nonurologic complications. Despite increases in central tumor, a trend was seen toward shorter warm/cold ischemic time in recent cases, and the overall complication rate did not change throughout the study period. With a median follow-up of 26 months for 1193 malignancies, recurrence occurred in 22 (1.7%) patients, including local recurrence in 7 (0.5%), lung in 8 (0.7%), lymph nodes in 2 (0.1%), and bone in 4 (0.3%). Of the 26 cases with positive surgical margins, local tumor recurrence occurred in only one.
  
  
  CONCLUSIONS
  This is the first nationwide survey of LPN in Japan to be reported. LPN could be performed with acceptable positive margins and complication rates. Most tumor recurrences occur as metastases, and surgical margin status appears to have little impact on oncologic outcomes.
authors.affiliation: Department of Urology, Tohoku University School of Medicine, Sendai, Miyagi, Japan.
authors.forename: Hideo
authors.initials: H
authors.lastname: Saito
authors.forename: Tadashi
authors.initials: T
authors.lastname: Matsuda
authors.forename: Kazunari
authors.initials: K
authors.lastname: Tanabe
authors.forename: Akihiro
authors.initials: A
authors.lastname: Kawauchi
authors.forename: Toshiro
authors.initials: T
authors.lastname: Terachi
authors.forename: Ken
authors.initials: K
authors.lastname: Nakagawa
authors.forename: Masatsugu
authors.initials: M
authors.lastname: Iwamura
authors.forename: Masanobu
authors.initials: M
authors.lastname: Shigeta
authors.forename: Katsunori
authors.initials: K
authors.lastname: Tatsugami
authors.forename: Akihiro
authors.initials: A
authors.lastname: Ito
authors.forename: Jiro
authors.initials: J
authors.lastname: Machida
authors.forename: Mutsushi
authors.initials: M
authors.lastname: Kawakita
authors.forename: Hidefumi
authors.initials: H
authors.lastname: Kinoshita
authors.forename: Nobuo
authors.initials: N
authors.lastname: Shinohara
authors.forename: Naomasa
authors.initials: N
authors.lastname: Ioritani
authors.forename: Toshimori
authors.initials: T
authors.lastname: Seki
authors.forename: Yoichi
authors.initials: Y
authors.lastname: Arai
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D005260:Female; D006801:Humans; D007564:Japan; D007680:Kidney Neoplasms / Q000473:pathology* / Q000601:surgery*; D010535:Laparoscopy / Q000009:adverse effects; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009392:Nephrectomy / Q000009:adverse effects / Q000379:methods*; D019990:Perioperative Care; D011183:Postoperative Complications / Q000209:etiology; D016019:Survival Analysis; D016896:Treatment Outcome; D055815:Young Adult