title: A snapshot of nephron-sparing surgery in Italy: a prospective, multicenter report on clinical and perioperative outcomes (the RECORd 1 project).
abstract: BACKGROUND
  Nephron-sparing surgery (NSS) has become the standard of care for the surgical management of small and clinically localized renal cell carcinoma (RCC). The conservative management of those RCCs is increasing over time. Aim of this study was to report a snapshot of the clinical, perioperative and oncological results after NSS for RCC in Italy.
  
  
  METHODS
  We evaluated all patients who underwent conservative surgical treatment for renal tumours between January 2009 and December 2012 at 19 urological Italian Centers (RECORd project). Perioperative, radiological and histopathological data were recorded. Surgical eras (2009 vs 2012 and year periods 2009-2010 vs 2011-2012) were compared.
  
  
  RESULTS
  Globally, 983 patients were evaluated. More recently, patients undergoing NSS were found to be significantly younger (p = 0.05) than those surgically treated in the first study period, with a significantly higher rate of NSS with relative and imperative indication (p < 0.001). More recently, a higher percentage of procedures for cT1b or cT2 renal tumours was observed (p = 0.02). Utilization rate of open partial nephrectomy (OPN) constantly decreased during years, laparoscopic partial nephrectomy (LPN) remained almost constant while robot-assisted partial nephrectomy (RAPN) increased. The rate of clampless NSS constantly increased over time. The use of at least one haemostatic agent has been significantly more adopted in the most recent surgical era (p < 0.001).
  
  
  CONCLUSIONS
  The utilization rate of NSS in Italy is increasing, even in elective and more complex cases. RAPN has been progressively adopted, as well as the intraoperative utilization of haemostatic agents and the rate of clampless procedures.
authors.affiliation: Dipartimento di Urologia, Università di Bologna, Ospedale S. Orsola-Malpighi, Bologna, Italy. Electronic address: rschiavina@yahoo.it.
authors.forename: R
authors.initials: R
authors.lastname: Schiavina
authors.affiliation: Clinica Urologica I, AOUC, Università di Firenze, Italy.
authors.forename: A
authors.initials: A
authors.lastname: Mari
authors.affiliation: Unità Operativa di Urologia Dipartimento di NefroUrologia, Azienda AO Spedali Civili di Brescia, Italy.
authors.forename: A
authors.initials: A
authors.lastname: Antonelli
authors.affiliation: Divisione di Urologia, Università di Torino, Ospedale San Luigi Gonzaga, Orbassano, Torino, Italy.
authors.forename: R
authors.initials: R
authors.lastname: Bertolo
authors.affiliation: Policlinico di Modena, Clinica Urologica, Università di Modena, Italy.
authors.forename: G
authors.initials: G
authors.lastname: Bianchi
authors.affiliation: Dipartimento di Urologia, Università di Bologna, Ospedale S. Orsola-Malpighi, Bologna, Italy; Dipartimento in Scienze Mediche e Chirurgiche (DIMEC), dottorato in Scienze Cardio Nefro Toraciche, Alma Mater Studiourum, Universita di Bologna, Bologna, Italy.
authors.forename: M
authors.initials: M
authors.lastname: Borghesi
authors.affiliation: Dipartimento di Urologia, Università di Bologna, Ospedale S. Orsola-Malpighi, Bologna, Italy.
authors.forename: E
authors.initials: E
authors.lastname: Brunocilla
authors.affiliation: Divisione di Urologia, Università di Torino, Ospedale San Luigi Gonzaga, Orbassano, Torino, Italy.
authors.forename: C
authors.initials: C
authors.lastname: Fiori
authors.affiliation: Policlinico Federico II, Università di Napoli, Italy.
authors.forename: N
authors.initials: N
authors.lastname: Longo
authors.affiliation: Dipartimento di Urologia, Università di Bologna, Ospedale S. Orsola-Malpighi, Bologna, Italy.
authors.forename: G
authors.initials: G
authors.lastname: Martorana
authors.affiliation: Policlinico Federico II, Università di Napoli, Italy.
authors.forename: V
authors.initials: V
authors.lastname: Mirone
authors.affiliation: Luna Foundation, Italy.
authors.forename: G
authors.initials: G
authors.lastname: Morgia
authors.affiliation: Clinica Urologica, Università di Padova, Padova, Italy.
authors.forename: G
authors.initials: G
authors.lastname: Novara
authors.affiliation: Divisione di Urologia, Università di Torino, Ospedale San Luigi Gonzaga, Orbassano, Torino, Italy.
authors.forename: F
authors.initials: F
authors.lastname: Porpiglia
authors.affiliation: I.R.C.C.S. Policlinico San Matteo - Struttura Di Urologia, Pavia, Italy.
authors.forename: B
authors.initials: B
authors.lastname: Rovereto
authors.affiliation: Clinica Urologica I, AOUC, Università di Firenze, Italy.
authors.forename: S
authors.initials: S
authors.lastname: Serni
authors.affiliation: Unità Operativa di Urologia Dipartimento di NefroUrologia, Azienda AO Spedali Civili di Brescia, Italy.
authors.forename: C
authors.initials: C
authors.lastname: Simeone
authors.affiliation: Unità Operativa di Urologia Dipartimento di NefroUrologia, Azienda AO Spedali Civili di Brescia, Italy.
authors.forename: M
authors.initials: M
authors.lastname: Sodano
authors.affiliation: Dipartimento di Urologia, Azienda Ospedaliera Maggiore Della Carità, Novara, Italy.
authors.forename: C
authors.initials: C
authors.lastname: Terrone
authors.affiliation: Clinica Urologica I, AOUC, Università di Firenze, Italy.
authors.forename: M
authors.initials: M
authors.lastname: Carini
authors.affiliation: Clinica Urologica I, AOUC, Università di Firenze, Italy.
authors.forename: A
authors.initials: A
authors.lastname: Minervini
mesh_terms: D017677:Age Distribution; D000368:Aged; D002292:Carcinoma, Renal Cell / Q000473:pathology / Q000601:surgery*; D015331:Cohort Studies; D005260:Female; D006801:Humans; D007558:Italy; D007680:Kidney Neoplasms / Q000473:pathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009392:Nephrectomy / Q000379:methods* / Q000639:trends; D009399:Nephrons; D061646:Operative Time; D059351:Organ Sparing Treatments / Q000379:methods* / Q000639:trends; D011446:Prospective Studies; D065287:Robotic Surgical Procedures / Q000639:trends; D016896:Treatment Outcome
keywords: Minimally invasive techniques; Nephron-sparing surgery; Outcomes; Partial nephrectomy; Renal cell carcinoma