title: Minimally invasive cytoreductive nephrectomy: a multi-institutional experience.
abstract: OBJECTIVE
  To analyze the functional and oncologic outcomes of minimally invasive cytoreductive nephrectomy (CN) in three high-volume cancer centers.
  
  
  METHODS
  Three prospectively maintained, IRB-approved kidney surgery databases were queried from three high-volume cancer centers. All patients who underwent minimally invasive surgery (laparoscopic, hand-assisted laparoscopic, or robotic) partial or radical CN with existing measurable extra-renal metastatic disease between May 2001 and May of 2013 were included in this analysis.
  
  
  RESULTS
  We identified 120 patients who underwent minimally invasive CN for metastatic renal cell carcinoma. Most of the surgeries were radical (93.3 %) and performed laparoscopically (96.6 %). Median operative time was 210 min, with a median estimated blood loss of 150 cc, and 11 (9.2 %) patients received blood transfusions. Four (3.3 %) patients were converted to open surgery due to locally advanced disease and/or bleeding. Postoperative complications were seen in 28 (23.3 %) patients, of which 20 (71.4 %) were classified as minor (Clavien-Dindo I-II). The median survival of the entire cohort was 25.7 months, with a 3-year survival rate of 35 %. Multivariate analysis indicated that only hypertension, brain metastasis, and pT stage were independently associated with worse overall survival (HR > 1).
  
  
  CONCLUSIONS
  Minimally invasive cytoreductive nephrectomy is feasible and safe in experienced hands with acceptable morbidity and oncological outcomes.
authors.affiliation: Department of Urology, Roswell Park Cancer Institute, Elm & Carlton Streets, Buffalo, NY, 14263, USA. Luciano.NunezBragayrac@RoswellPark.org.
authors.forename: Luciano
authors.initials: L
authors.lastname: Nunez Bragayrac
authors.affiliation: Otto von Guericke Universität Magdeburg, Magdeburg, Germany.
authors.forename: Jan
authors.initials: J
authors.lastname: Hoffmeyer
authors.affiliation: Department of Urology, Roswell Park Cancer Institute, Elm & Carlton Streets, Buffalo, NY, 14263, USA.
authors.forename: Daniel
authors.initials: D
authors.lastname: Abbotoy
authors.affiliation: Department of Biostatistics and Bioinformatics, Roswell Park Cancer Institute, Buffalo, NY, USA.
authors.forename: Kristopher
authors.initials: K
authors.lastname: Attwood
authors.affiliation: Department of Urology, Roswell Park Cancer Institute, Elm & Carlton Streets, Buffalo, NY, 14263, USA.
authors.forename: Eric
authors.initials: E
authors.lastname: Kauffman
authors.affiliation: Moffiit Cancer Center, Tampa, FL, USA.
authors.forename: Phillipe
authors.initials: P
authors.lastname: Spiess
authors.affiliation: Beth Israel Deaconess Medical Center, Boston, MA, USA.
authors.forename: Andrew
authors.initials: A
authors.lastname: Wagner
authors.affiliation: Department of Urology, Roswell Park Cancer Institute, Elm & Carlton Streets, Buffalo, NY, 14263, USA.
authors.forename: Thomas
authors.initials: T
authors.lastname: Schwaab
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002292:Carcinoma, Renal Cell / Q000175:diagnosis / Q000556:secondary / Q000601:surgery*; D065426:Cytoreduction Surgical Procedures / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007680:Kidney Neoplasms / Q000473:pathology / Q000601:surgery*; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009362:Neoplasm Metastasis; D009392:Nephrectomy / Q000379:methods*; D061646:Operative Time; D011446:Prospective Studies; D012371:Robotics / Q000379:methods*; D016896:Treatment Outcome; D055815:Young Adult
keywords: Cytoreductive nephrectomy; Metastatic kidney cancer; Minimally invasive surgery; Renal cell carcinoma