title: Oncologic and Functional Outcomes of Laparoendoscopic Single-Site Radical Nephrectomy for Localized Kidney Cancer: A Single Surgeon's Series with a Minimum of 3-Year Follow-Up.
abstract: OBJECTIVE
  To evaluate intermediate-term oncologic and renal functional outcome of laparoendoscopic single-site radical nephrectomy (LESS-RN) in the treatment of localized kidney cancer.
  
  
  METHODS
  We performed a chart review of patients who underwent LESS-RN between 2009 and 2011 at our institution. Patients with a minimum of 3 years of follow-up were included in this study. The demographic data and main perioperative outcome variables were analyzed. Estimated glomerular filtration rate was calculated using the Modification of Diet Renal Disease equation. Upstaging of chronic kidney disease (CKD) was calculated. The Kaplan-Meier method was used to calculate overall survival (OS), cancer-specific survival (CSS), and cancer-free survival (CFS). Multivariate logistic regression was performed to show predicting factors for an undesirable outcome arbitrarily defined as any one or more of the following events: surgical conversion, complication of Clavien grade >2, new onset of CKD stages ≥3 at the latest follow-up, or cancer recurrence or metastasis.
  
  
  RESULTS
  A total of 51 patients were included with a median follow-up of 41 (interquartile range: 38-45) months. The OS, CSS, and CFS rates at 3 years were 100%, 100%, and 98%, respectively. There was a 74.5% (38/51) upstaging of CKD at the latest follow-up, with 22 patients (43.1%) who developed a new onset of CKD stages ≥3. Multivariate analysis showed that patient age, body mass index, Charlson comorbidity index, early surgeon experience, and follow-up duration (all p < 0.05) have increased the odds of an undesirable outcome.
  
  
  CONCLUSIONS
  For localized kidney cancer, LESS-RN is effective in oncologic control at an intermediate follow-up interval but, similar to other kinds of RN technique, it is associated with worsened renal functional outcomes.
authors.affiliation: 1 Department of Urology, Affiliated Tumor Hospital of Guangxi Medical University , Nanning, P.R. China .
authors.forename: Jiwen
authors.initials: J
authors.lastname: Cheng
authors.affiliation: 2 Department of Urology, Changzheng Hospital, Second Military Medical University , Shanghai, P.R. China .|3 Department of Urology, Henan Provincial Corps Hospital of Chinese People's Armed Police Forces , Zhengzhou, P.R. China .
authors.forename: Junming
authors.initials: J
authors.lastname: Chen
authors.affiliation: 4 Department of Urology, Changhai Hospital, Second Military Medical University , Shanghai, P.R. China .
authors.forename: Xia
authors.initials: X
authors.lastname: Sheng
authors.affiliation: 2 Department of Urology, Changzheng Hospital, Second Military Medical University , Shanghai, P.R. China .
authors.forename: Yifan
authors.initials: Y
authors.lastname: Xu
authors.affiliation: 2 Department of Urology, Changzheng Hospital, Second Military Medical University , Shanghai, P.R. China .
authors.forename: Yi
authors.initials: Y
authors.lastname: Bao
authors.affiliation: 4 Department of Urology, Changhai Hospital, Second Military Medical University , Shanghai, P.R. China .
authors.forename: Liang
authors.initials: L
authors.lastname: Xiao
authors.affiliation: 2 Department of Urology, Changzheng Hospital, Second Military Medical University , Shanghai, P.R. China .
authors.forename: Bing
authors.initials: B
authors.lastname: Liu
authors.affiliation: 2 Department of Urology, Changzheng Hospital, Second Military Medical University , Shanghai, P.R. China .
authors.forename: Zhenjie
authors.initials: Z
authors.lastname: Wu
authors.affiliation: 2 Department of Urology, Changzheng Hospital, Second Military Medical University , Shanghai, P.R. China .
authors.forename: Linhui
authors.initials: L
authors.lastname: Wang
authors.affiliation: 4 Department of Urology, Changhai Hospital, Second Military Medical University , Shanghai, P.R. China .
authors.forename: Yinghao
authors.initials: Y
authors.lastname: Sun
mesh_terms: D000368:Aged; D002292:Carcinoma, Renal Cell / Q000601:surgery*; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D005919:Glomerular Filtration Rate; D006801:Humans; D007680:Kidney Neoplasms / Q000601:surgery*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009392:Nephrectomy / Q000379:methods*; D011183:Postoperative Complications / Q000503:physiopathology*; D051436:Renal Insufficiency, Chronic / Q000503:physiopathology*; D012189:Retrospective Studies; D012307:Risk Factors; D066231:Surgeons; D015996:Survival Rate