title: Open versus laparoscopic partial nephrectomy for clinical T1a renal masses: a matched-pair comparison of 280 patients with TRIFECTA outcomes (RECORd Project).
abstract: OBJECTIVE
  To report a matched-pair comparative analysis between open (OPN) and laparoscopic partial nephrectomy (LPN) for clinical (c) T1a renal masses from a large prospective multicenter dataset.
  
  
  METHODS
  The RECORd Project includes all patients who underwent OPN and LPN for kidney cancer between January 2009 and January 2011 at 19 Italian centers. Open and laparoscopic groups were compared regarding clinical, surgical, pathologic, functional results and TRIFECTA outcome. Multivariable logistic regression models were used to analyze predictors of WIT >25 min, surgical complications (SC) and the achievement of the TRIFECTA outcome.
  
  
  RESULTS
  Overall, 301 patients had OPN and 149 LPN. Groups were matched 1:1 (140 matched pairs) for clinical diameter, tumor location and type of indication. Laparoscopic partial nephrectomy was associated with a significantly mean longer WIT (19.9 vs. 15.1 min; p < 0.001), and it was an independent predictor of a WIT >25 min (RR 6.29, p < 0.0001). The TRIFECTA was achieved in 78.6 and 74.3% after OPN and LPN (p = ns), respectively, and the surgical approach was not a predictor of a negative TRIFECTA and SC at multivariable analysis. At 6-month follow-up, no significant differences were observed between the OPN and LPN group both in estimated glomerular filtration rate (eGFR) (∆GFR 1.1 vs. 4.1 mL/min) and in new-onset stage III-V chronic kidney disease (CKD) rate (0 vs. 0.7%).
  
  
  CONCLUSIONS
  No significant difference in achieving the TRIFECTA outcome was reported after OPN and LPN. LPN was associated with a significantly longer WIT. However, eGFR at 6-month follow-up did not differ significantly between the two surgical approaches.
authors.affiliation: Clinica Urologica I, AOUC, Università di Firenze, Florence, Italy.
authors.forename: Andrea
authors.initials: A
authors.lastname: Minervini
authors.forename: Giampaolo
authors.initials: G
authors.lastname: Siena
authors.forename: Alessandro
authors.initials: A
authors.lastname: Antonelli
authors.forename: Giampaolo
authors.initials: G
authors.lastname: Bianchi
authors.forename: Aldo Massimo
authors.initials: AM
authors.lastname: Bocciardi
authors.forename: Sergio
authors.initials: S
authors.lastname: Cosciani Cunico
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Ficarra
authors.forename: Cristian
authors.initials: C
authors.lastname: Fiori
authors.forename: Ferdinando
authors.initials: F
authors.lastname: Fusco
authors.forename: Andrea
authors.initials: A
authors.lastname: Mari
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Martorana
authors.forename: Mauro
authors.initials: M
authors.lastname: Medica
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Mirone
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Morgia
authors.forename: Francesco
authors.initials: F
authors.lastname: Porpiglia
authors.forename: Francesco
authors.initials: F
authors.lastname: Rocco
authors.forename: Bruno
authors.initials: B
authors.lastname: Rovereto
authors.forename: Riccardo
authors.initials: R
authors.lastname: Schiavina
authors.forename: Claudio
authors.initials: C
authors.lastname: Simeone
authors.forename: Carlo
authors.initials: C
authors.lastname: Terrone
authors.forename: Alessandro
authors.initials: A
authors.lastname: Volpe
authors.forename: Marco
authors.initials: M
authors.lastname: Carini
authors.forename: Sergio
authors.initials: S
authors.lastname: Serni
mesh_terms: D000368:Aged; D005260:Female; D005500:Follow-Up Studies; D005919:Glomerular Filtration Rate / Q000502:physiology; D006801:Humans; D007668:Kidney / Q000503:physiopathology / Q000601:surgery; D007680:Kidney Neoplasms / Q000473:pathology* / Q000503:physiopathology / Q000601:surgery*; D010535:Laparoscopy / Q000379:methods*; D016015:Logistic Models; D008297:Male; D016555:Matched-Pair Analysis; D008875:Middle Aged; D009367:Neoplasm Staging; D009392:Nephrectomy / Q000379:methods*; D011446:Prospective Studies; D016896:Treatment Outcome