title: Robotic partial nephrectomy for clinical stage T1b tumors: intermediate oncologic and functional outcomes.
abstract: OBJECTIVE
  The objective of this study was to examine our intermediate oncologic and functional outcomes of robotic partial nephrectomy for clinical T1b tumors. Partial nephrectomy has become the gold standard of treatment for small renal masses. Recently, indications for minimally invasive partial nephrectomy have extended to larger and more complicated renal masses in some centers.
  
  
  METHODS
  Between July 2008 and September 2013, 241 robotic partial nephrectomies were performed at our institution, including 46 for clinical ≥ T1b tumors. We reviewed the intermediate-term functional and oncologic outcomes of this cohort of patients.
  
  
  RESULTS
  Of the 46 patients, the median age was 55.5 years (interquartile range [IQR], 51-68 years) with a median body mass index of 31.6 (IQR, 27.4-38.9), tumor diameter of 5.0 cm (IQR, 4.1-5.2 cm), and RENAL nephrometry score of 7.1 (range, 5-11). Renal cell carcinoma was confirmed in 35 patients, and 11 patients had benign pathology. There was 1 patient with an established positive margin and 2 patients had a focal positive margin. At a median follow-up of 24.3 months (range, 2.3-61.1 months), the overall, recurrence-free and cancer-specific survival was 97.1%, 97.1%, and 100%, respectively. No patient progressed to dialysis postoperatively and there was no significant difference between preoperative and postoperative serum creatinine or estimated glomerular filtration rate using the Modification of Diet in Renal Disease equation.
  
  
  CONCLUSIONS
  Because of the many adverse medical effects of chronic renal insufficiency, the indications for partial nephrectomy are expanding at many institutions. We demonstrated that robotic partial nephrectomy is a safe and efficacious procedure for the treatment of T1b renal tumors with excellent intermediate oncologic and functional outcomes.
authors.affiliation: Department of Urology, Tulane University School of Medicine, New Orleans, LA.
authors.forename: Michael
authors.initials: M
authors.lastname: Maddox
authors.affiliation: Department of Urology, Tulane University School of Medicine, New Orleans, LA.
authors.forename: Sree
authors.initials: S
authors.lastname: Mandava
authors.affiliation: Department of Urology, Tulane University School of Medicine, New Orleans, LA.
authors.forename: James
authors.initials: J
authors.lastname: Liu
authors.affiliation: Department of Urology, Tulane University School of Medicine, New Orleans, LA.
authors.forename: Aaron
authors.initials: A
authors.lastname: Boonjindasup
authors.affiliation: Department of Urology, Tulane University School of Medicine, New Orleans, LA. Electronic address: brlee@tulane.edu.
authors.forename: Benjamin R
authors.initials: BR
authors.lastname: Lee
mesh_terms: D000368:Aged; D002292:Carcinoma, Renal Cell / Q000473:pathology / Q000601:surgery*; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D007677:Kidney Function Tests; D007680:Kidney Neoplasms / Q000473:pathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009392:Nephrectomy / Q000295:instrumentation* / Q000379:methods; D065287:Robotic Surgical Procedures / Q000379:methods*; D016896:Treatment Outcome
keywords: Kidney cancer; Nephron sparing surgery; Partial nephrectomy; Renal cell carcinoma; Robotics