title: Robot-assisted partial nephrectomy for renal tumors larger than 4 cm: results of a multicenter, international series.
abstract: BACKGROUND
  Limited data are available for the use of robot-assisted partial nephrectomy (RAPN) in tumors >4 cm. The objectives of this study were to report the perioperative outcomes of a series of patients who underwent RAPN for suspicious >4 cm renal tumors and to compare these results with those observed in a group of patients with ≤4 cm tumors.
  
  
  METHODS
  We analyzed retrospectively the clinical records of 49 patients who underwent RAPN for suspicious of renal cell carcinoma (RCC) >4 cm in size at four centers from September 2008 to September 2010. All patients underwent da Vinci RAPN. The results were compared with those observed in a group of patients undergoing RAPN for ≤4 cm renal tumors.
  
  
  RESULTS
  The median warm ischemia time (WIT) was 22 min (Interquartile range [IQR] 18-28). The median console time was 145 min (median IQR 112-177). The median blood loss was 120 mL (IQR 62-237). In two cases, we observed intraoperative renal vein injury (4 %). Postoperative complications were reported in 13 (26.5 %) patients. Major complications were observed in 4 (8.2 %) cases. Patients with large tumors showed perioperative outcomes worse than those received the RAPN for ≤4 cm tumors. Conversely, no significant difference was observed in positive surgical margin (PSM) rates.
  
  
  CONCLUSIONS
  These outcomes support the use of RAPN as possible alternative to open PN for the treatment for patients with suspicious renal masses >4 cm. Positive surgical margin rates demonstrated RAPN is an oncologically safe procedure for tumors >4 cm.
authors.affiliation: OLV Robotic Surgery Institute, Onze Lieve Vrouw (O.L.V.) Clinic Aalst, Moorselbaan 164, 9300 Aalst, Belgium. vincenzo.ficarra@unipd.it
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Ficarra
authors.forename: Sam
authors.initials: S
authors.lastname: Bhayani
authors.forename: James
authors.initials: J
authors.lastname: Porter
authors.forename: Nicolò
authors.initials: N
authors.lastname: Buffi
authors.forename: Robin
authors.initials: R
authors.lastname: Lee
authors.forename: Andrea
authors.initials: A
authors.lastname: Cestari
authors.forename: Giacomo
authors.initials: G
authors.lastname: Novara
authors.forename: Alexander
authors.initials: A
authors.lastname: Mottrie
mesh_terms: D000368:Aged; D016063:Blood Loss, Surgical; D002291:Carcinoma, Papillary / Q000473:pathology / Q000601:surgery; D002292:Carcinoma, Renal Cell / Q000473:pathology / Q000601:surgery*; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D007680:Kidney Neoplasms / Q000473:pathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D009392:Nephrectomy / Q000379:methods*; D011183:Postoperative Complications / Q000209:etiology; D012189:Retrospective Studies; D012371:Robotics / Q000379:methods*; D016896:Treatment Outcome; D052096:Warm Ischemia