title: Robot-assisted partial nephrectomy for ≥ 7 cm renal masses: a comparative outcome analysis.
abstract: OBJECTIVE
  To present our robotic partial nephrectomy (RPN) experience for renal masses ≥ 7 cm and compare the surgical outcomes in this cohort with those obtained for small (≤ 4 cm) renal masses.
  
  
  METHODS
  We retrospectively reviewed our institutional review board-approved RPN database and identified patients undergoing RPN for tumors ≥ 7 cm. Surgical technique, renal function, oncologic, and pathologic data were analyzed and compared with the RPN for renal masses ≤ 4 cm.
  
  
  RESULTS
  Overall, 441 patients were identified for the purpose of this study, including 29 cases and 412 controls. Median operative time (200 vs 180 min; P = .005), warm ischemia time (26.5 vs 19 min; P <.001), and estimated blood loss (250 mL [353] vs 150 mL [150]; P <.001) were significantly lower in the control group. Postoperative complications were significantly higher in the case group (37.9% vs 15.8%; P = .005). However, the percentages of major complications (Clavien grade ≥ III) were comparable (18.2% vs 17%; P = .57 for cases and controls respectively). Postoperative blood transfusion was higher for larger tumor group (24.1% vs 4.1%; P <.001). Positive margins were similar between groups (5.9% vs 3.3%; P = .45 for cases and controls respectively). There was no difference in estimated glomerular filtration rate decline between the two groups (12.2% vs 15.8% decline; P = .98).
  
  
  CONCLUSIONS
  RPN represents a feasible and safe nephron-sparing surgery approach for highly selected (mostly exophytic growth pattern, polar location, and likelihood of benign histology) renal masses ≥ 7 cm in diameter.
authors.affiliation: Glickman Urological and Kidney Institute, Cleveland Clinic, OH.
authors.forename: Luis Felipe
authors.initials: LF
authors.lastname: Brandao
authors.affiliation: Glickman Urological and Kidney Institute, Cleveland Clinic, OH.
authors.forename: Homayoun
authors.initials: H
authors.lastname: Zargar
authors.affiliation: Glickman Urological and Kidney Institute, Cleveland Clinic, OH.
authors.forename: Riccardo
authors.initials: R
authors.lastname: Autorino
authors.affiliation: Glickman Urological and Kidney Institute, Cleveland Clinic, OH.
authors.forename: Oktay
authors.initials: O
authors.lastname: Akca
authors.affiliation: Glickman Urological and Kidney Institute, Cleveland Clinic, OH.
authors.forename: Humberto
authors.initials: H
authors.lastname: Laydner
authors.affiliation: Glickman Urological and Kidney Institute, Cleveland Clinic, OH.
authors.forename: Dinesh
authors.initials: D
authors.lastname: Samarasekera
authors.affiliation: Glickman Urological and Kidney Institute, Cleveland Clinic, OH.
authors.forename: Jayram
authors.initials: J
authors.lastname: Krishnan
authors.affiliation: Glickman Urological and Kidney Institute, Cleveland Clinic, OH.
authors.forename: Georges-Pascal
authors.initials: GP
authors.lastname: Haber
authors.affiliation: Glickman Urological and Kidney Institute, Cleveland Clinic, OH.
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Stein
authors.affiliation: Glickman Urological and Kidney Institute, Cleveland Clinic, OH. Electronic address: kaoukj@ccf.org.
authors.forename: Jihad H
authors.initials: JH
authors.lastname: Kaouk
mesh_terms: D000368:Aged; D016022:Case-Control Studies; D005260:Female; D006801:Humans; D007680:Kidney Neoplasms / Q000601:surgery*; D010535:Laparoscopy / Q000379:methods; D008297:Male; D008875:Middle Aged; D009392:Nephrectomy / Q000379:methods*; D012189:Retrospective Studies; D012371:Robotics; D013514:Surgical Procedures, Operative; D016896:Treatment Outcome; D052096:Warm Ischemia