title: Robotic partial nephrectomy for completely endophytic renal tumors: complications and functional and oncologic outcomes during a 4-year median period of follow-up.
abstract: OBJECTIVE
  To evaluate the renal functional outcome, the oncologic safety, and the occurrence of complications after robotic-assisted laparoscopic partial nephrectomy (RPN) for completely endophytic tumors.
  
  
  METHODS
  Data of 45 patients with completely endophytic tumors, 116 patients with mesophytic, and 64 patients with exophytic masses who underwent RPN were retrospectively analyzed. Perioperative, oncologic, and functional data were evaluated and analyzed with SPSS, version 18.
  
  
  RESULTS
  Demographic characteristics were similar among the groups. The median follow-up of the endophytic, the mesophytic, and the exophytic groups were 48, 43, and 38 months, respectively. Endophytic masses were more likely to be malignant and have a higher overall tumor complexity, estimated by the RENAL score (9 vs 8 vs 5.5; P <.01; P = .02). We did not detect any statistically significant differences among the groups regarding blood loss volume, transfusion rates, length of stay, and intraoperative and postoperative complications (P = .49, .25, .87, .42, and .20, respectively). There was a statistically significant difference in the estimated glomerular filtration rate percentage change on the first postoperative day (P = .02), but this significance was not observed after the first week. The patients in the endophytic group showed a tendency toward increased rates of positive surgical margins compared with the mesophytic and exophytic groups (P = .06). However, there were not any significant differences regarding the recurrence-free survival rates (P = .335) and the overall mortality rates (P = .570) according to the Kaplan-Meier analysis.
  
  
  CONCLUSIONS
  In experienced institutes, RPN for entirely intraparenchymal masses is a feasible procedure in terms of complication rates, functional and oncologic outcomes during an intermediate-term period of follow-up.
authors.affiliation: Department of Urology and Urological Science Institute, Yonsei University College of Medicine, Seoul, Republic of Korea; Department of Urology, General Hospital of Nikaia "St. Panteleimon", Athens, Greece.
authors.forename: Christos
authors.initials: C
authors.lastname: Komninos
authors.affiliation: Department of Urology, Chuncheon Sacred Hospital, Hallym Medical College, Chuncheon, Korea.
authors.forename: Tae Young
authors.initials: TY
authors.lastname: Shin
authors.affiliation: Department of Urology and Urological Science Institute, Yonsei University College of Medicine, Seoul, Republic of Korea.
authors.forename: Patrick
authors.initials: P
authors.lastname: Tuliao
authors.affiliation: Department of Urology and Urological Science Institute, Yonsei University College of Medicine, Seoul, Republic of Korea.
authors.forename: Dae Keun
authors.initials: DK
authors.lastname: Kim
authors.affiliation: Department of Urology and Urological Science Institute, Yonsei University College of Medicine, Seoul, Republic of Korea.
authors.forename: Woong Kyu
authors.initials: WK
authors.lastname: Han
authors.affiliation: Department of Urology and Urological Science Institute, Yonsei University College of Medicine, Seoul, Republic of Korea.
authors.forename: Byung Ha
authors.initials: BH
authors.lastname: Chung
authors.affiliation: Department of Urology and Urological Science Institute, Yonsei University College of Medicine, Seoul, Republic of Korea.
authors.forename: Young Deuk
authors.initials: YD
authors.lastname: Choi
authors.affiliation: Department of Urology and Urological Science Institute, Yonsei University College of Medicine, Seoul, Republic of Korea. Electronic address: khrha@yuhs.ac.
authors.forename: Koon Ho
authors.initials: KH
authors.lastname: Rha
mesh_terms: D000328:Adult; D002292:Carcinoma, Renal Cell / Q000401:mortality / Q000473:pathology* / Q000601:surgery*; D015331:Cohort Studies; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D053208:Kaplan-Meier Estimate; D007680:Kidney Neoplasms / Q000401:mortality / Q000473:pathology* / Q000601:surgery*; D010535:Laparoscopy / Q000009:adverse effects / Q000379:methods; D008297:Male; D008875:Middle Aged; D009392:Nephrectomy / Q000009:adverse effects / Q000379:methods*; D011183:Postoperative Complications / Q000401:mortality / Q000503:physiopathology; D012189:Retrospective Studies; D018570:Risk Assessment; D012371:Robotics / Q000379:methods*; D015996:Survival Rate; D013997:Time Factors; D016896:Treatment Outcome