title: Long-term oncologic outcomes of minimally invasive partial nephrectomy for renal-cell carcinoma.
abstract: OBJECTIVE
  To report the long-term oncologic outcomes and survival estimates associated with minimally invasive partial nephrectomy (MIPN) and to determine factors associated with those outcomes and survival estimates.
  
  
  METHODS
  A single-institution, retrospective review was performed on all patients undergoing MIPN for renal-cell carcinoma between 1998 and 2011 with minimum 1-year follow-up. Bivariate and multivariate analyses were performed to assess associations between demographic, perioperative, and tumor factors with recurrence and survival. Survival was estimated using the Kaplan-Meier method.
  
  
  RESULTS
  Of 417 patients undergoing MIPN, median overall and oncologic follow-up were 3.3 and 2.9 years, respectively. The mean patient age was 63 years (standard deviation [SD]± 13.4). The mean tumor size was 2.9 cm (SD ± 1.48). Only 6.7% of patients had a pathologic stage T2 or greater. There was only one cancer-related death. Estimates for overall survival at 2, 5, and 10 years were 95.6%, 89.1%, and 70.7%, respectively. Estimates for recurrence-free survival (any recurrence) at 2, 5, and 10 years were 98.2%, 93.5%, and 88.3%, respectively. On multivariate analysis, only tumor stage was associated with recurrence, and only patient age and American Society of Anesthesiologists score were associated with overall survival. Technical aspects of the procedure, such as positive margins or use of enucleation, did not influence recurrence or survival.
  
  
  CONCLUSIONS
  Cancer recurrence after MIPN, in a cohort of patients with mostly pT1 tumors, is rare. Recurrence and overall survival are associated with nonmodifiable factors rather than technical ones.
authors.affiliation: Department of Urology, University of Michigan Hospitals and Health Centers , Ann Arbor, Michigan.
authors.forename: Anudeep
authors.initials: A
authors.lastname: Mukkamala
authors.forename: Chang
authors.initials: C
authors.lastname: He
authors.forename: Alon Z
authors.initials: AZ
authors.lastname: Weizer
authors.forename: Khaled S
authors.initials: KS
authors.lastname: Hafez
authors.forename: David C
authors.initials: DC
authors.lastname: Miller
authors.forename: Jeffrey S
authors.initials: JS
authors.lastname: Montgomery
authors.forename: J Stuart
authors.initials: JS
authors.lastname: Wolf
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000776:Anesthesiology; D002292:Carcinoma, Renal Cell / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D005260:Female; D006801:Humans; D007680:Kidney Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009364:Neoplasm Recurrence, Local / Q000401:mortality / Q000473:pathology; D009367:Neoplasm Staging; D009392:Nephrectomy / Q000379:methods* / Q000401:mortality; D012189:Retrospective Studies; D016896:Treatment Outcome; D047368:Tumor Burden