title: Five-year Oncologic Outcomes After Transperitoneal Robotic Partial Nephrectomy for Renal Cell Carcinoma.
abstract: Robotic partial nephrectomy (RPN) is established as a minimally invasive nephron-sparing technique with excellent perioperative and intermediate oncologic outcomes. However, long-term oncologic outcomes have not been reported to date.
  
  
  
  To report long-term oncologic outcomes of RPN.
  
  
  
  Consecutive patients undergoing RPN from June 2006 to March 2010 were selected from our prospective RPN database. Patients with benign tumors, prior ipsilateral PN, or prior radical nephrectomy and those with follow-up of <1 mo were excluded.
  
  
  
  Transperitoneal RPN.
  
  
  
  Demographic, perioperative, and postoperative data were analyzed. Overall survival (OS), cancer-free survival (CFS), and cancer-specific survival (CSS) were evaluated using Kaplan-Meier survival analysis. Univariate logistic regression analysis for overall mortality was performed to evaluate the odds ratio (OR) for variables of interest.
  
  
  
  In total, 115 RPNs for RCC were performed in 110 patients. The mean age was 59.8±11.0 yr and the median age-adjusted Charlson comorbidity index (ACCI) was 4 (interquartile range [IQR] 3-5). The median tumor size was 2.6cm (IQR 2.0-3.7) and median RENAL score was 7 (IQR 6-9). Clear cell carcinoma was present in 67.8% of cases, and two cases (1.7%) had positive surgical margins. Glomerular filtration rate preservation was 87.8% (IQR 74.9-98.1), which translates to 19.1% chronic kidney disease upstaging. The median follow-up was 61.9 mo (IQR 50.9-71.4) and the 5-yr OS, CFS, and CSS were 91.1%, 97.8%, and 97.8%, respectively. On univariable logistic regression, ACCI was the only factor associated with a higher risk of overall mortality (OR 1.67, p=0.006). The retrospective design, the high surgical volume at our institution, and the potential selection bias with careful patient selection early in the RPN experience may limit the generalizability of our findings.
  
  
  
  This is the first study confirming excellent long-term oncologic outcomes after RPN in a selected cohort of patients.
  
  
  
  Robotic partial nephrectomy is a relatively recently developed treatment for renal cell carcinoma. This study confirms its safety and reports excellent long-term cancer control.
authors.affiliation: Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA.
authors.forename: Hiury S
authors.initials: HS
authors.lastname: Andrade
authors.affiliation: Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA.
authors.forename: Homayoun
authors.initials: H
authors.lastname: Zargar
authors.affiliation: Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA.
authors.forename: Peter A
authors.initials: PA
authors.lastname: Caputo
authors.affiliation: Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA.
authors.forename: Oktay
authors.initials: O
authors.lastname: Akca
authors.affiliation: Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA.
authors.forename: Onder
authors.initials: O
authors.lastname: Kara
authors.affiliation: Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA.
authors.forename: Daniel
authors.initials: D
authors.lastname: Ramirez
authors.affiliation: Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA.
authors.forename: Georges-Pascal
authors.initials: GP
authors.lastname: Haber
authors.affiliation: Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA.
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Stein
authors.affiliation: Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA. Electronic address: kaoukj@ccf.org.
authors.forename: Jihad H
authors.initials: JH
authors.lastname: Kaouk
mesh_terms: D000368:Aged; D002292:Carcinoma, Renal Cell / Q000473:pathology / Q000601:surgery*; D015897:Comorbidity; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D053208:Kaplan-Meier Estimate; D007680:Kidney Neoplasms / Q000473:pathology / Q000601:surgery*; D008297:Male; D000072662:Margins of Excision; D008875:Middle Aged; D009392:Nephrectomy / Q000379:methods*; D059351:Organ Sparing Treatments; D012189:Retrospective Studies; D065287:Robotic Surgical Procedures / Q000379:methods*; D015996:Survival Rate; D013997:Time Factors; D047368:Tumor Burden
keywords: Long-term outcome; Minimally invasive surgery; Oncology; Renal cell carcinoma; Robotic partial nephrectomy