title: A propensity-matched comparison of perioperative complications and of chronic kidney disease between robot-assisted laparoscopic partial nephrectomy and radiofrequency ablative therapy.
abstract: OBJECTIVE
  The study presents a matched-pair analysis of robot-assisted laparoscopic partial nephrectomy (RALPN) versus radiofrequency ablation (RFA) to compare the perioperative incidence of complications and chronic kidney disease (CKD).
  
  
  METHODS
  All 46 RFA and 206 RALPN cases from June 2005 to December 2011 were retrospectively reviewed from the medical records and were matched 1:1 based on propensity scores by sex, tumor size, tumor laterality of kidney, tumor location within the kidney, and clinical T stage. Hilar vessel clamping was performed in all RALPN patients. The estimated glomerular filtration rate was used to define the CKD of < 60 mL/minute/1.73 m(2) by the Modification of Diet in Renal Disease equation. All patients with baseline CKD or solitary kidney were excluded prior to the matching analysis. The complication was noted with modified Clavien grades ≥ 3. Statistical analysis was performed to compare the perioperative incidence of complications and CKD.
  
  
  RESULTS
  A total of 27 matched pairs of RFA and RALPN patients were enrolled for analyzing CKD and perioperative complications. The better general conditions, higher estimated blood loss and transfusion rates, and longer operative time and hospital stay were observed significantly in RALPN patients (p < 0.05). Matched analysis demonstrated that the incidences of both perioperative complications (p = 0.434) and of CKD (p = 0.500) were not significantly different. No complication higher than Grade 4 was detected in either group.
  
  
  CONCLUSIONS
  Despite the intraoperative renal ischemia and invasiveness of the procedure associated with RALPN, the incidence of perioperative complication and of CKD developing rates were statistically similar.
authors.affiliation: Department of Urology, National Cancer Center, Goyang, Gyeonggi, South Korea.
authors.forename: Sung Han
authors.initials: SH
authors.lastname: Kim
authors.affiliation: Department of Urology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, South Korea.
authors.forename: Eun-Sik
authors.initials: ES
authors.lastname: Lee
authors.affiliation: Department of Urology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, South Korea.
authors.forename: Hyeon Hoe
authors.initials: HH
authors.lastname: Kim
authors.affiliation: Department of Urology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, South Korea.
authors.forename: Cheol
authors.initials: C
authors.lastname: Kwak
authors.affiliation: Department of Urology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, South Korea.
authors.forename: Ja Hyeon
authors.initials: JH
authors.lastname: Ku
authors.affiliation: Department of Urology, Seoul National University Bun-Dang Hospital, Seoul, South Korea.
authors.forename: Sang Eun
authors.initials: SE
authors.lastname: Lee
authors.affiliation: Department of Urology, Seoul National University Bun-Dang Hospital, Seoul, South Korea.
authors.forename: Sung Kyu
authors.initials: SK
authors.lastname: Hong
authors.affiliation: Department of Urology, Seoul National University Bun-Dang Hospital, Seoul, South Korea.
authors.forename: Chang Wook
authors.initials: CW
authors.lastname: Jeong
authors.affiliation: Department of Urology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, South Korea.
authors.forename: Seung Hyup
authors.initials: SH
authors.lastname: Kim
authors.affiliation: Department of Urology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, South Korea.
authors.forename: Jeong Yeon
authors.initials: JY
authors.lastname: Cho
authors.affiliation: Department of Urology, Seoul National University Bun-Dang Hospital, Seoul, South Korea.
authors.forename: Sung Il
authors.initials: SI
authors.lastname: Hwang
authors.affiliation: Department of Urology, Seoul National University Bun-Dang Hospital, Seoul, South Korea.
authors.forename: Hak Jong
authors.initials: HJ
authors.lastname: Lee
authors.affiliation: Department of Urology, Seoul National University Bun-Dang Hospital, Seoul, South Korea. Electronic address: ssbyun@snubh.org.
authors.forename: Seok Soo
authors.initials: SS
authors.lastname: Byun
mesh_terms: D000328:Adult; D000368:Aged; D002292:Carcinoma, Renal Cell / Q000601:surgery; D017115:Catheter Ablation; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D007680:Kidney Neoplasms / Q000601:surgery*; D010535:Laparoscopy; D008297:Male; D016555:Matched-Pair Analysis; D008875:Middle Aged; D009392:Nephrectomy / Q000379:methods*; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology*; D057216:Propensity Score; D051436:Renal Insufficiency, Chronic / Q000453:epidemiology / Q000209:etiology*; D012189:Retrospective Studies; D065287:Robotic Surgical Procedures; D016896:Treatment Outcome
keywords: ablation techniques; laparoscopy; nephrectomy; pulsed radiofrequency ablation treatment; renal cell carcinoma