title: Robotic partial nephrectomy: imperative vs elective indications.
abstract: OBJECTIVE
  To assess the impact of imperative or elective indications on the perioperative outcomes of patients undergoing robotic partial nephrectomy.
  
  
  METHODS
  Between January 2008 and August 2011, 381 consecutive robotic partial nephrectomies were retrospectively included. Two groups of patients were identified: those who underwent the procedure for an imperative indication (n = 98) and those who underwent the procedure for an elective indication (n = 283). Perioperative and renal function outcomes were compared between the 2 groups. Multivariate analysis was performed to determine whether imperative indications were predictors of complications, chronic kidney disease stage upstaging, postoperative estimated glomerular filtration rate, and percentage of estimated glomerular filtration rate decrease.
  
  
  RESULTS
  There were no differences between the 2 groups with respect to RENAL score and tumor size. Patients in the imperative group were more likely to have a higher Charlson Comorbidity Index score (6 vs 4, P < .001), higher chronic kidney disease stage (P < .001), and lower estimated glomerular filtration rate (61.9 vs 88.6 mL/min/1.73 m(2), P < .001). Perioperative outcomes were similar with respect to warm ischemia time, estimated blood loss, operative time, transfusion rate, positive surgical margin rate, and length of stay. Imperative indications were associated with higher major complication rate (7.22% vs 2.47%, P = .032), but not with overall (31.6% vs 26%, P = .62) and intraoperative complications (6.1% vs 3.2%, P = .22). In multivariate analysis, imperative indication was an independent predictor of postoperative estimated glomerular filtration rate but was not a predictor of percentage of estimated glomerular filtration rate decrease and chronic kidney disease upstaging.
  
  
  CONCLUSIONS
  Patients undergoing robotic partial nephrectomy for an imperative indication have similar functional outcomes than those with an elective indication. However, they are at higher risk of major complications.
authors.affiliation: Section of Laparoscopic and Robotic Surgery, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH 44195, USA.
authors.forename: Jean-Alexandre
authors.initials: JA
authors.lastname: Long
authors.forename: Byron
authors.initials: B
authors.lastname: Lee
authors.forename: Remi
authors.initials: R
authors.lastname: Eyraud
authors.forename: Riccardo
authors.initials: R
authors.lastname: Autorino
authors.forename: Shahab
authors.initials: S
authors.lastname: Hillyer
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; D016063:Blood Loss, Surgical; D001803:Blood Transfusion; D015992:Body Mass Index; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D007431:Intraoperative Complications / Q000209:etiology*; D007680:Kidney Neoplasms / Q000473:pathology / Q000601:surgery*; D007902:Length of Stay; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D018365:Neoplasm, Residual; D009392:Nephrectomy / Q000009:adverse effects; D061646:Operative Time; D059035:Perioperative Period; D011183:Postoperative Complications / Q000209:etiology*; D051436:Renal Insufficiency, Chronic / Q000503:physiopathology / Q000601:surgery*; D012189:Retrospective Studies; D012371:Robotics; D018709:Statistics, Nonparametric; D052096:Warm Ischemia