title: A prospective comparison of surgical and pathological outcomes obtained after robot-assisted or pure laparoscopic partial nephrectomy in moderate to complex renal tumours: results from a French multicentre collaborative study.
abstract: OBJECTIVE
  To prospectively compare the surgical and pathological outcomes obtained with robot-assisted laparoscopic partial nephrectomy (RAPN) or laparoscopic PN (LPN) for renal cell carcinoma in a multicentre cohort.
  
  
  METHODS
  Between 2007 and 2011, 265 nephron-sparing surgeries were performed at six French urology departments. The patients underwent either RAPN (n = 220) or LPN (n = 45) procedures. The operative data included operative duration, warm ischaemia time (WIT) and estimated blood loss (EBL). The postoperative outcomes included length of stay (LOS), creatinine variation (Modification of Diet in Renal Disease group), Clavien complications and pathological results. The complexity of the renal tumour was classified using the R.E.N.A.L. nephrometry scoring system. Student's t-test and chi-squared tests were used to compare variables.
  
  
  RESULTS
  The median follow-ups for the RAPN and LPN groups were 7 and 18 months, respectively (P < 0.001). Age and American Society of Anesthesiology score were significantly higher in the LPN group (P = 0.02 and P = 0.004, respectively). These variables were lower in the RAPN group: WIT [mean (sd) 20.4 (9.7) vs 24.3 (15.2) min; P = 0.03], operative duration [mean (sd) 168.1 (55.5) vs 199.7 (51.2) min; P < 0.001], operating room occupation time [mean (sd) 248.3 (66.7) vs 278.2 (71.3) min; P = 0.008], EBL [mean (sd) 244.8 (365.4) vs 268.3 (244.9) mL; P = 0.01], use of haemostatic agents [used in 78% of RAPNs and 100% of LPNs; P < 0.001] and LOS [mean (sd) 5.5 (4.3) vs 6.8 (3.2) days; P = 0.05). There were no significant differences between pre- and postoperative creatinine levels, pathology report or complication rates between the groups. The main limitation was due to the study's non-randomised design.
  
  
  CONCLUSIONS
  RAPN is not inferior to pure LPN for perioperative outcomes (i.e. EBL, operative duration, WIT, LOS). Only a randomised study with a longer follow-up can now provide further insight into oncological outcomes.
authors.affiliation: Department of Urology, Pitié Salpétrière, Assistance Publique - Hôpitaux de Paris, France.
authors.forename: Alexandra
authors.initials: A
authors.lastname: Masson-Lecomte
authors.forename: Karim
authors.initials: K
authors.lastname: Bensalah
authors.forename: Elise
authors.initials: E
authors.lastname: Seringe
authors.forename: Christophe
authors.initials: C
authors.lastname: Vaessen
authors.forename: Alexandre
authors.initials: A
authors.lastname: de la Taille
authors.forename: Nicolas
authors.initials: N
authors.lastname: Doumerc
authors.forename: Pascal
authors.initials: P
authors.lastname: Rischmann
authors.forename: Franck
authors.initials: F
authors.lastname: Bruyère
authors.forename: Laurent
authors.initials: L
authors.lastname: Soustelle
authors.forename: Stéphane
authors.initials: S
authors.lastname: Droupy
authors.forename: Morgan
authors.initials: M
authors.lastname: Rouprêt
mesh_terms: D000328:Adult; D000368:Aged; D016063:Blood Loss, Surgical; D003404:Creatinine / Q000378:metabolism; D005260:Female; D005602:France; D005919:Glomerular Filtration Rate; D006801:Humans; D007680:Kidney Neoplasms / Q000473:pathology / Q000503:physiopathology / Q000601:surgery*; D010535:Laparoscopy / Q000379:methods*; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009392:Nephrectomy / Q000379:methods*; D061646:Operative Time; D059351:Organ Sparing Treatments / Q000379:methods; D011183:Postoperative Complications / Q000209:etiology; D011446:Prospective Studies; D012371:Robotics / Q000379:methods*; D052096:Warm Ischemia
chemical_list: D003404:Creatinine