title: Robotic partial nephrectomy versus laparoscopic cryoablation for the small renal mass.
abstract: BACKGROUND
  Open partial nephrectomy (OPN) remains the gold standard for treatment of small renal masses (SRMs). Laparoscopic cryoablation (LCA) has provided encouraging outcomes. Robotic partial nephrectomy (RPN) represents a new promising option but is still under evaluation.
  
  
  OBJECTIVE
  Compare the outcomes of RPN and LCA in the treatment of patients with SRMs.
  
  
  METHODS
  We retrospectively analyzed the medical charts of patients with SRMs (≤4cm) who underwent minimally invasive nephron-sparing surgery (RPN or LCA) in our institution from January 1998 to December 2010.
  
  
  METHODS
  RPN and LCA.
  
  
  METHODS
  Perioperative complications and functional and oncologic outcomes were analyzed.
  
  
  CONCLUSIONS
  A total of 446 SRMs were identified in 436 patients (RPN, n=210; LCA, n=226). Patients undergoing RPN were younger (p<0.0001), had a lower American Society of Anesthesiologists score (p<0.001), and higher baseline preoperative estimated glomerular filtration rate (eGFR) (p<0.0001). Mean tumor size was smaller in the LCA group (2.2 vs 2.4cm; p=0.004). RPN was associated with longer operative time (180 vs 165min; p=0.01), increased estimated blood loss (200 vs 75ml; p<0.0001), longer hospital stay (72 vs 48h; p<0.0001), and higher morbidity rate (20% vs 12%, p=0.015). Mean follow-ups for RPN and LCA were 4.8 mo and 44.5 mo, respectively (p<0.0001). Local recurrence rates for RPN and LCA were 0% and 11%, respectively (p<0.0001). Mean eGFR decrease after RPN and LCA was insignificant at 1 mo, at 6 mo after surgery, and during last follow-up. Limitations include retrospective study design, length of follow-up, and selection bias.
  
  
  CONCLUSIONS
  Both techniques remain viable treatment options in the management of SRMs. A higher incidence of perioperative complications was found in patients undergoing RPN. However, the technique was not predictive of the occurrence of postoperative complications. Early oncologic outcomes are promising for RPN, which also seems to be associated with better preservation of renal function. Long-term follow-up and well-designed prospective comparative studies are awaited to corroborate these findings.
authors.affiliation: Center for Laparoscopic and Robotic Surgery, Cleveland Clinic, Cleveland, OH, USA.
authors.forename: Julien
authors.initials: J
authors.lastname: Guillotreau
authors.forename: Georges-Pascal
authors.initials: GP
authors.lastname: Haber
authors.forename: Riccardo
authors.initials: R
authors.lastname: Autorino
authors.forename: Ranko
authors.initials: R
authors.lastname: Miocinovic
authors.forename: Shahab
authors.initials: S
authors.lastname: Hillyer
authors.forename: Adrian
authors.initials: A
authors.lastname: Hernandez
authors.forename: Humberto
authors.initials: H
authors.lastname: Laydner
authors.forename: Rachid
authors.initials: R
authors.lastname: Yakoubi
authors.forename: Wahib
authors.initials: W
authors.lastname: Isac
authors.forename: Jean-Alexandre
authors.initials: JA
authors.lastname: Long
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Stein
authors.forename: Jihad H
authors.initials: JH
authors.lastname: Kaouk
mesh_terms: D000368:Aged; D002292:Carcinoma, Renal Cell / Q000503:physiopathology / Q000601:surgery*; D003452:Cryosurgery / Q000295:instrumentation / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D005919:Glomerular Filtration Rate; D006801:Humans; D015994:Incidence; D007680:Kidney Neoplasms / Q000503:physiopathology / Q000601:surgery*; D010535:Laparoscopy / Q000295:instrumentation / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009392:Nephrectomy / Q000295:instrumentation / Q000379:methods*; D012371:Robotics / Q000379:methods* / Q000706:statistics & numerical data; D016896:Treatment Outcome