title: Three-year oncologic and renal functional outcomes after robot-assisted partial nephrectomy.
abstract: BACKGROUND
  With the wider adoption of minimally invasive partial nephrectomy (PN), intermediate- and long-term outcomes data are needed to make firm conclusions about oncologic and functional efficacy, especially for robot-assisted PN (RPN).
  
  
  OBJECTIVE
  To report intermediate-term oncologic and renal functional outcomes of RPN.
  
  
  METHODS
  We performed a chart review of patients who had undergone RPN since June 2006; patients with a minimum of 2 yr of follow-up were included in this study. Length of follow-up was calculated from the date of surgery to the date of last clinical follow-up. Patients who were either lost to follow-up or who had follow-up outside of our center were sent surveys.
  
  
  METHODS
  Transperitoneal RPN with or without hilar clamping.
  
  
  METHODS
  The demographic, preoperative, and postoperative data were statistically analyzed. The Kaplan-Meier method was used to calculate overall survival (OS), cancer-specific survival (CSS), and cancer-free survival (CFS). Upstaging of chronic kidney disease (CKD) was calculated, as well. Univariate and multivariate analyses were performed to show predicting factors for the latest estimated glomerular filtration rate (eGFR).
  
  
  CONCLUSIONS
  Of 427 patients, 134 had a minimum follow-up of 2 yr, and 70 had a minimum of 3-6 yr of follow-up. The mean age was 59.1±12.5 yr, body mass index (BMI) was 29.8±6.2 kg/m(2), and Charlson comorbidity index (CCI) score was 4.2±1.6. The mean tumor size on computed tomography (CT) scan was 3.0±1.6 cm, RENAL score was 7.2±1.8, estimated blood loss (EBL) was 270.7±291.9 ml, operative time was 189.1±54.8 min, and warm ischemia time (WIT) was 17.9±10.3 min. A total of two intraoperative complications (1.5%) and five high-grade Clavien complications (3.7%) occurred. Patients stayed on average for 3.7±1.7 d in the hospital, and the average follow-up was 3.0±0.9 yr. OS was 97.01% at 3 yr and 90.20% at 5 yr; CFS was 98.92% at 3 yr and 98.92% at 5 yr; and CSS was 99.04%, as projected by the Kaplan-Meier method. The mean preoperative GFR was 88.2±0.8 ml/min per 1.73 m(2); the latest postoperative GFR was 80±24 ml/min per 1.73 m(2), with a 8±17.4% change. There was a 20.2% upstaging of CKD postoperatively, but no patients started dialysis.
  
  
  CONCLUSIONS
  This study reaffirms that RPN is effective in renal function preservation and oncologic control at an intermediate follow-up interval.
authors: Center for Laparoscopic and Robotic Surgery, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA.
authors: Ali
authors: A
authors: Khalifeh
authors: Riccardo
authors: R
authors: Autorino
authors: Remi
authors: R
authors: Eyraud
authors: Dinesh
authors: D
authors: Samarasekera
authors: Humberto
authors: H
authors: Laydner
authors: Kamol
authors: K
authors: Panumatrassamee
authors: Robert J
authors: RJ
authors: Stein
authors: Jihad H
authors: JH
authors: Kaouk
mesh_terms: D000368:Aged; D018572:Disease-Free Survival; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D053208:Kaplan-Meier Estimate; D007680:Kidney Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009392:Nephrectomy / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D011183:Postoperative Complications / Q000209:etiology; D012189:Retrospective Studies; D012307:Risk Factors; D012371:Robotics; D025321:Surgery, Computer-Assisted / Q000009:adverse effects / Q000401:mortality; D013997:Time Factors; D016896:Treatment Outcome
keywords: Follow-up; Kidney; Nephron sparing; Outcomes; Renal cancer; Robotic partial nephrectomy