title: Partial Nephrectomy in Clinical T1b Renal Tumors: Multicenter Comparative Study of Open, Laparoscopic and Robot-assisted Approach (the RECORd Project).
abstract: OBJECTIVE
  To evaluate perioperative results of open (OPN), laparoscopic (LPN), and robot-assisted partial nephrectomies (RAPN) and to identify predictive factors of Trifecta achievement for clinical T1b renal tumors in a multicenter prospective dataset.
  
  
  METHODS
  Data of 285 patients who had OPN (133), LPN (57), or RAPN (95) for cT1b renal tumors were extracted from the RECORd Project. High-volume centers were defined as ≥50 overall cases of partial nephrectomy per year. Trifecta was defined as simultaneous absence of perioperative complications, negative surgical margins, and ischemia time <25 minutes.
  
  
  RESULTS
  The 3 groups had comparable body mass index, preoperative hemoglobin, creatinine and estimated glomerular filtration rate, tumor clinical diameter, and growth pattern. LPN and RAPN were more frequently exclusive of high-volume centers. RAPN showed significantly lower median estimated blood loss compared with OPN and LPN. Trifecta was achieved in 62.4%, 63.2%, and 69.5% of OPN, LPN, and RAPN (P = NS) cases. Median warm ischemia time (WIT) was significantly shorter during OPN than during LPN and RAPN. RAPN had significantly shorter WIT compared with LPN. RAPN was significantly less morbid than OPN regarding intraoperative and postoperative complications. LPN (1.9%) and RAPN (2.5%) showed a lower rate of positive margins compared with OPN (6.8%) (P = NS). At multivariable analysis, exophytic tumor growth pattern, estimated blood loss, and high-volume centers were significant predictive factors for Trifecta achievement.
  
  
  CONCLUSIONS
  Clinically, T1b renal tumors suitable for NSS can be safely treated by LPN or RAPN in high-volume centers. RAPN allows for significantly lower WIT and estimated blood loss with higher rate of Trifecta achievement compared with LPN.
authors.affiliation: Department of Urology, University of Turin, Ospedale San Luigi Gonzaga, Orbassano, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Porpiglia
authors.affiliation: Department of Urology, Careggi Hospital, University of Florence, Florence, Italy.
authors.forename: Andrea
authors.initials: A
authors.lastname: Mari
authors.affiliation: Department of Urology, University of Turin, Ospedale San Luigi Gonzaga, Orbassano, Italy.
authors.forename: Riccardo
authors.initials: R
authors.lastname: Bertolo
authors.affiliation: Department of Urology, Azienda AO Spedali Civili di Brescia, Italy.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Antonelli
authors.affiliation: Policlinico di Modena, Department of Urology, University of Modena, Italy.
authors.forename: Giampaolo
authors.initials: G
authors.lastname: Bianchi
authors.affiliation: Policlinico di Modena, Department of Urology, University of Modena, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Fidanza
authors.affiliation: Department of Urology, University of Turin, Ospedale San Luigi Gonzaga, Orbassano, Italy.
authors.forename: Cristian
authors.initials: C
authors.lastname: Fiori
authors.affiliation: Department of Urology, Azienda AO Spedali Civili di Brescia, Italy.
authors.forename: Maria
authors.initials: M
authors.lastname: Furlan
authors.affiliation: Luna Foundation.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Morgia
authors.affiliation: Department of Urology, University of Padua, Italy.
authors.forename: Giacomo
authors.initials: G
authors.lastname: Novara
authors.affiliation: Department of Urology, University of Padua, I.R.C.C.S. Foundation Ca' Granda-Ospedale Maggiore Policlinico, Milan, Italy.
authors.forename: Bernardo
authors.initials: B
authors.lastname: Rocco
authors.affiliation: I.R.C.C.S. Policlinico San Matteo-Department of Urology, Pavia, Italy.
authors.forename: Bruno
authors.initials: B
authors.lastname: Rovereto
authors.affiliation: Department of Urology, Careggi Hospital, University of Florence, Florence, Italy.
authors.forename: Sergio
authors.initials: S
authors.lastname: Serni
authors.affiliation: Department of Urology, Azienda AO Spedali Civili di Brescia, Italy.
authors.forename: Claudio
authors.initials: C
authors.lastname: Simeone
authors.affiliation: Department of Urology, Careggi Hospital, University of Florence, Florence, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Carini
authors.affiliation: Department of Urology, Careggi Hospital, University of Florence, Florence, Italy. Electronic address: andreamine@libero.it.
authors.forename: Andrea
authors.initials: A
authors.lastname: Minervini
mesh_terms: D005260:Female; D006801:Humans; D007680:Kidney Neoplasms / Q000473:pathology / Q000601:surgery*; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D009392:Nephrectomy / Q000379:methods*; D011446:Prospective Studies; D065287:Robotic Surgical Procedures