title: Robotic versus laparoscopic partial nephrectomy for complex tumors: comparison of perioperative outcomes.
abstract: BACKGROUND
  Recent studies showed that robotic partial nephrectomy (RPN) offered outcomes at least comparable to those of laparoscopic partial nephrectomy (LPN). LPN can be particularly challenging for more complex tumors.
  
  
  OBJECTIVE
  To compare the perioperative outcomes of patients undergoing LPN or RPN for a single renal mass of moderate or high complexity.
  
  
  METHODS
  A retrospective analysis was performed for 381 consecutive patients who underwent either LPN (n = 182) or RPN (n = 199) between 2005 and 2011 for a complex renal mass (RENAL score ≥ 7). Perioperative outcomes were compared. Predictors of postoperative renal function were assessed using multivariable linear regression analysis.
  
  
  METHODS
  LPN or RPN.
  
  
  METHODS
  Perioperative outcomes were compared. Predictors of postoperative renal function were assessed using multivariable linear regression analysis.
  
  
  CONCLUSIONS
  There was no significant difference between the two groups with respect to patient age, gender, side, American Society of Anesthesiologists score, Charlson comorbidity index (CCI), or tumor size. Patients undergoing LPN had a slightly lower body mass index (29.2 kg/m(2) compared with 30.7 kg/m(2), p = 0.02) and preoperative estimated glomerular filtration rate (eGFR) (81.1 compared with 86.0 ml/min per 1.73 m(2), p = 0.02). LPN was associated with an increased rate of conversion to radical nephrectomy (RN) (11.5% compared with 1%, p<0.001) and a higher decrease in percentage of eGFR (-16.0% compared with -12.6%, p = 0.03). There were no significant differences with respect to warm ischemia time (WIT), estimated blood loss, transfusion rate, or postoperative complications. WIT, preoperative eGFR, and CCI were found to be predictors of postoperative eGFR in multivariable analysis. No difference in perioperative outcomes was found between moderate and high RENAL score subgroups. The retrospective study design was the main limitation of this study.
  
  
  CONCLUSIONS
  RPN provides functional outcomes comparable to those of LPN for moderate- to high-complexity tumors, but with a significantly lower risk of conversion to RN. This situation is likely because of the technical advantages offered by the articulated robotic instruments. A prospective randomized study is needed to confirm these findings.
authors.affiliation: Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH 44195, USA.
authors.forename: Jean-Alexandre
authors.initials: JA
authors.lastname: Long
authors.forename: Rachid
authors.initials: R
authors.lastname: Yakoubi
authors.forename: Byron
authors.initials: B
authors.lastname: Lee
authors.forename: Julien
authors.initials: J
authors.lastname: Guillotreau
authors.forename: Riccardo
authors.initials: R
authors.lastname: Autorino
authors.forename: Humberto
authors.initials: H
authors.lastname: Laydner
authors.forename: Remi
authors.initials: R
authors.lastname: Eyraud
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Stein
authors.forename: Jihad H
authors.initials: JH
authors.lastname: Kaouk
authors.forename: Georges-Pascal
authors.initials: GP
authors.lastname: Haber
mesh_terms: D000368:Aged; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D007680:Kidney Neoplasms / Q000473:pathology / Q000601:surgery*; D010535:Laparoscopy / Q000009:adverse effects; D016014:Linear Models; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009392:Nephrectomy / Q000009:adverse effects / Q000379:methods*; D009820:Ohio; D059035:Perioperative Period; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D012371:Robotics; D025321:Surgery, Computer-Assisted / Q000009:adverse effects; D013997:Time Factors; D016896:Treatment Outcome