title: Comparison of robot-assisted and laparoscopic partial nephrectomy for complex renal tumours with a RENAL nephrometry score ≥7: peri-operative and oncological outcomes.
abstract: OBJECTIVE
  To evaluate the peri-operative, functional and oncological outcomes of robot-assisted partial nephrectomy (RAPN) and laparoscopic partial nephrectomy (LPN) for moderately or highly complex tumours (defined as RENAL nephrometry score ≥7).
  
  
  METHODS
  We retrospectively analysed the medical charts of 216 patients with complex tumours who underwent LPN (n = 135) or RAPN (n = 81) between 2008 and 2014. Peri-operative data, pathological variables, complications, functional and oncological outcomes were reviewed.
  
  
  RESULTS
  Demographic characteristics were similar in the two groups. LPN was associated with a longer operating time (149.6 vs 135.6 min; P = 0.017) and greater estimated blood loss (220.8 vs 196.5 mL; P = 0.013). RAPN was associated with a higher direct cost. There were no differences in warm ischaemia time, transfusion rate, conversion rate, hospital stay, operative complications and estimated glomerular filtration rate change at 6 months after surgery. The mean follow-ups for LPN and RAPN were 31.4 and 16.5 months, respectively. The 3-year recurrence-free survival rate was 95.2% for LPN and 97.1% for RAPN (P = 0.71).
  
  
  CONCLUSIONS
  In patients with complex tumours, RAPN and LPN provided acceptable and similar results in terms of peri-operative, functional and oncological outcomes. RAPN was superior to LPN in terms of estimated blood loss and operating time, and LPN was the more cost-effective approach. Both surgery techniques remain viable options in the management of complex tumours with RENAL scores ≥7.
authors.affiliation: Department of Urology, Chinese People's Liberation Army General Hospital, Beijing, China.|Department of Urology, Shanxi Provincial People's Hospital, Taiyuan, China.
authors.forename: Yubin
authors.initials: Y
authors.lastname: Wang
authors.affiliation: Department of Urology, Chinese People's Liberation Army General Hospital, Beijing, China.
authors.forename: Xin
authors.initials: X
authors.lastname: Ma
authors.affiliation: Department of Urology, Chinese People's Liberation Army General Hospital, Beijing, China.
authors.forename: Qingbo
authors.initials: Q
authors.lastname: Huang
authors.affiliation: Department of Urology, Chinese People's Liberation Army General Hospital, Beijing, China.
authors.forename: Qingshan
authors.initials: Q
authors.lastname: Du
authors.affiliation: Department of Urology, Chinese People's Liberation Army General Hospital, Beijing, China.
authors.forename: Huijie
authors.initials: H
authors.lastname: Gong
authors.affiliation: Department of Urology, Chinese People's Liberation Army General Hospital, Beijing, China.
authors.forename: Jiwen
authors.initials: J
authors.lastname: Shang
authors.affiliation: Department of Urology, Chinese People's Liberation Army General Hospital, Beijing, China.
authors.forename: Xu
authors.initials: X
authors.lastname: Zhang
mesh_terms: D000368:Aged; D006801:Humans; D007680:Kidney Neoplasms / Q000453:epidemiology / Q000601:surgery*; D010535:Laparoscopy / Q000009:adverse effects / Q000379:methods / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D009392:Nephrectomy / Q000009:adverse effects / Q000379:methods / Q000706:statistics & numerical data; D011183:Postoperative Complications / Q000453:epidemiology; D012189:Retrospective Studies; D065287:Robotic Surgical Procedures / Q000009:adverse effects / Q000379:methods / Q000706:statistics & numerical data; D016896:Treatment Outcome
keywords: RENAL; laparoscopy; nephrometry score; partial nephrectomy; renal cell carcinoma; robotics