title: Perioperative outcomes of robotic and open partial nephrectomy for moderately and highly complex renal lesions.
abstract: OBJECTIVE
  We compared outcomes in patients undergoing robotic vs open partial nephrectomy stratified by moderately and highly complex tumor nephrometry scores.
  
  
  METHODS
  Patients treated with partial nephrectomy from 2007 to 2010 were grouped by tumor characteristics into low-nephrotomy score 4 to 6, moderate-7 to 9 and high-10 to 12 anatomical complexity cohorts. Lesions with low complexity were excluded from study. Demographic, surgical and pathological outcomes were compared between patients undergoing robotic vs open partial nephrectomy in the moderately and highly complex cohorts.
  
  
  RESULTS
  A total of 281 patients, of whom 63.3% were male, with a mean±SD age of 58.1±11.7 years and a mean followup of 21.3±16.3 months underwent partial nephrectomy. Moderately complex lesions were noted in 81 robotic and 136 open partial nephrectomy cases with a mean tumor size of 3.8±2.2 cm. Highly complex lesions were noted in 10 robotic and 54 open partial nephrectomy cases with a mean tumor size of 4.8±3.0 cm. There were no differences between the groups in patient age, race, gender, body mass index or American Society of Anesthesiologists classification. Cases treated with open partial nephrectomy for moderately or highly complex lesions were of higher pathological stage (p=0.02 and 0.01, respectively). The percent change in creatinine and the glomerular filtration rate were similar for robotic and open partial nephrectomy in the moderately and highly complex tumor groups. In patients undergoing robotic vs open partial nephrectomy for moderately complex lesions we noted differences in pathological tumor size (mean 3.2±1.8 vs 4.1±2.3 cm, p<0.0001) and operative time (205.9±52.5 vs 189.5±52.0 minutes, p<0.01) while decreased estimated blood loss (131.3±127.8 vs 256.5±291.3 ml) and hospital length of stay (3.7±1.6 vs 5.6±3.9 days, each p<0.001) were observed in the robotic group. Comparison of highly complex lesions revealed decreased hospital length of stay (2.9±1.4 vs 6.1±4.1 days, p<0.0001) in the robotic partial nephrectomy group.
  
  
  CONCLUSIONS
  In our large institutional series of patients with moderate and highly complex solid renal tumors classified by the nephrometry score robotic partial nephrectomy offered comparable perioperative and functional outcomes with the added benefit of decreased hospital length of stay.
authors.affiliation: Division of Urologic Oncology, Department of Surgical Oncology, Fox Chase Cancer Center, Temple University School of Medicine, Philadelphia, Pennsylvania 19111, USA.
authors.forename: Jay
authors.initials: J
authors.lastname: Simhan
authors.forename: Marc C
authors.initials: MC
authors.lastname: Smaldone
authors.forename: Kevin J
authors.initials: KJ
authors.lastname: Tsai
authors.forename: Tianyu
authors.initials: T
authors.lastname: Li
authors.forename: Jose M
authors.initials: JM
authors.lastname: Reyes
authors.forename: Daniel
authors.initials: D
authors.lastname: Canter
authors.forename: Alexander
authors.initials: A
authors.lastname: Kutikov
authors.forename: David Y T
authors.initials: DY
authors.lastname: Chen
authors.forename: Richard E
authors.initials: RE
authors.lastname: Greenberg
authors.forename: Robert G
authors.initials: RG
authors.lastname: Uzzo
authors.forename: Rosalia
authors.initials: R
authors.lastname: Viterbo
mesh_terms: D000368:Aged; D005260:Female; D006801:Humans; D007668:Kidney / Q000601:surgery*; D007680:Kidney Neoplasms / Q000473:pathology / Q000601:surgery*; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009392:Nephrectomy / Q000379:methods*; D059035:Perioperative Period; D012371:Robotics; D016896:Treatment Outcome