title: Laparoscopic Partial Nephrectomy for T1 Renal Cell Carcinoma: Comparison of Two Resection Techniques in a Multi-institutional Propensity Score-Matching Analysis.
abstract: BACKGROUND
  Enucleoresection is defined as presence of a minimal paratumor parenchyma that allows for clear visualization of the tumor's contours during partial nephrectomy (PN). Because there is variability in published reports regarding resection techniques during PN before the surface-intermediate-base (SIB) margin score reporting system, the association between postoperative outcomes and resection techniques are rarely reported. This study was designed to compare the perioperative, oncologic, and functional outcomes between laparoscopic enucleoresection (LER) (SIB score 1 + 1 + 1 = 3) and traditional laparoscopic partial nephrectomy (TLPN) (SIB score 1 + 2 + 2 = 5).
  
  
  METHODS
  Data from 270 consecutive patients who underwent laparoscopic partial nephrectomy for single T1 RCC at 3 medical centers were prospectively collected. Propensity score matching was performed on age, gender, body mass index, American Society of Anesthesiologists score, preoperative estimated glomerular filtration rate (eGFR), tumor size, RENAL nephrometry score, Charlson score, and solitary kidney status. Normal parenchyma width of each patient was evaluated right after the surgery, and SIB score was assigned retrospectively. Ninety-eight matched patients undergoing LER or TLPN were compared for perioperative, oncologic, and functional outcomes.
  
  
  RESULTS
  After matching, warm ischemia time (WIT) and operative time were significantly shorter in LER than TLPN group (20.8 vs. 23.8 min, P = 0.003 and 130.8 vs. 152.1 min, P = 0.005, respectively). Estimated blood loss (EBL) also was lower in LER than TLPN group (50 vs. 90 mL, P = 0.045). Complication rates, positive surgical margin rates, and local recurrence rates were comparable between groups (P = 0.3, P = 0.62, and P = 1.0, respectively). At last follow-up, the eGFRs also were comparable in both groups (P = 0.6).
  
  
  CONCLUSIONS
  LER has similar oncologic, functional outcomes and complication rates with the advantage of a shorter WIT, operative time, and lower EBL compared with TLPN.
authors.affiliation: Department of Urology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China.
authors.forename: Wen
authors.initials: W
authors.lastname: Dong
authors.affiliation: Department of Urology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China.
authors.forename: Tianxin
authors.initials: T
authors.lastname: Lin
authors.affiliation: Department of Urology, Nanfang Hospital, Southern Medical University, Guangzhou, China.
authors.forename: Fei
authors.initials: F
authors.lastname: Li
authors.affiliation: Department of Urology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.
authors.forename: Yong
authors.initials: Y
authors.lastname: Fang
authors.affiliation: Department of Urology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China.
authors.forename: Kaiwen
authors.initials: K
authors.lastname: Li
authors.affiliation: Department of Urology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China.
authors.forename: Kewei
authors.initials: K
authors.lastname: Xu
authors.affiliation: Department of Urology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China.
authors.forename: Chun
authors.initials: C
authors.lastname: Jiang
authors.affiliation: Department of Pathology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China.
authors.forename: Lijuan
authors.initials: L
authors.lastname: Bian
authors.affiliation: Department of Urology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China.
authors.forename: Jinli
authors.initials: J
authors.lastname: Han
authors.affiliation: Department of Urology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China.
authors.forename: Hai
authors.initials: H
authors.lastname: Huang
authors.affiliation: Department of Urology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China.
authors.forename: Hao
authors.initials: H
authors.lastname: Liu
authors.affiliation: Department of Urology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China.
authors.forename: Xinxiang
authors.initials: X
authors.lastname: Fan
authors.affiliation: Department of Urology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China.
authors.forename: Caixia
authors.initials: C
authors.lastname: Zhang
authors.affiliation: Department of Radiology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China.
authors.forename: Xiaofeng
authors.initials: X
authors.lastname: Lin
authors.affiliation: Department of Urology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China.
authors.forename: Wenlian
authors.initials: W
authors.lastname: Xie
authors.affiliation: Department of Urology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China.
authors.forename: Yousheng
authors.initials: Y
authors.lastname: Yao
authors.affiliation: Department of Urology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China.
authors.forename: Qiuping
authors.initials: Q
authors.lastname: Ma
authors.affiliation: Department of Urology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China.
authors.forename: Yuechun
authors.initials: Y
authors.lastname: Chen
authors.affiliation: Department of Urology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China.
authors.forename: Zhongyu
authors.initials: Z
authors.lastname: Huang
authors.affiliation: Department of Urology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.
authors.forename: Chi
authors.initials: C
authors.lastname: Zhang
authors.affiliation: Department of Urology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China. chenw3@mail.sysu.edu.cn.
authors.forename: Wei
authors.initials: W
authors.lastname: Chen
authors.affiliation: Department of Urology, Nanfang Hospital, Southern Medical University, Guangzhou, China. twl@smu.edu.cn.
authors.forename: Wanlong
authors.initials: W
authors.lastname: Tan
authors.affiliation: Department of Urology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China. urolhj@sina.com.
authors.forename: Jian
authors.initials: J
authors.lastname: Huang
mesh_terms: D002291:Carcinoma, Papillary / Q000473:pathology / Q000601:surgery; D002292:Carcinoma, Renal Cell / Q000473:pathology / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007680:Kidney Neoplasms / Q000473:pathology / Q000601:surgery*; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000473:pathology / Q000601:surgery*; D009367:Neoplasm Staging; D009392:Nephrectomy / Q000379:methods*; D061646:Operative Time; D011183:Postoperative Complications; D011379:Prognosis; D057216:Propensity Score; D012189:Retrospective Studies; D012371:Robotics / Q000379:methods; D015996:Survival Rate; D052096:Warm Ischemia