title: American Confederation of Urology (CAU) experience in minimally invasive partial nephrectomy.
abstract: OBJECTIVE
  To describe the perioperative and oncology outcomes in a series of laparoscopic or robotic partial nephrectomies (PN) for renal tumors treated in diverse institutions of Hispanic America from the beginning of their minimally invasive (MI) PN experience through December 2014.
  
  
  METHODS
  Seventeen institutions participated in the CAU generated a MI PN database. We estimated proportions, medians, 95 % confidence intervals, Kaplan-Meier curves, multivariate logistic and Cox regression analyses. Clavien-Dindo classification was used.
  
  
  RESULTS
  We evaluated 1501 laparoscopic (98 %) or robotic (2 %) PNs. Median age: 58 years. Median surgical time, warm ischemia and intraoperative bleeding were 150, 20 min and 200 cc. 81 % of the lesions were malignant, with clear cell histology being 65 % of the total. Median maximum tumor diameter is 2.7 cm, positive margin is 8.2 %, and median hospitalization is 3 days. One or more postoperative complication was recorded in 19.8 % of the patients: Clavien 1: 5.6 %; Clavien 2: 8.4 %; Clavien 3A: 1.5 %; Clavien 3B: 3.2 %; Clavien 4A: 1 %; Clavien 4B: 0.1 %; Clavien 5: 0 %. Bleeding was the main cause of a reoperation (5.5 %), conversion to radical nephrectomy (3 %) or open partial nephrectomy (6 %). Transfusion rate is 10 %. In multivariate analysis, RENAL nephrometry score was the only variable associated with complications (OR 1.1; 95 % CI 1.02-1.2; p = 0.02). Nineteen patients presented disease progression or died of disease in a median follow-up of 1.37 years. The 5-year progression or kidney cancer mortality-free rate was 94 % (95 % CI 90, 97). Positive margins (HR 4.98; 95 % CI 1.3-19; p = 0.02) and females (HR 5.6; 95 % CI 1.7-19; p = 0.005) were associated with disease progression or kidney cancer mortality after adjusting for maximum tumor diameter.
  
  
  CONCLUSIONS
  Laparoscopic PN in these centers of Hispanic America seem to have acceptable perioperative complications and short-term oncologic outcomes.
authors.affiliation: San Lázaro and FUNDES Foundation, Buenos Aires, Argentina. fsecin@yahoo.com.|CEMIC University Hospital, Buenos Aires, Argentina. fsecin@yahoo.com.
authors.forename: Fernando P
authors.initials: FP
authors.lastname: Secin
authors.affiliation: Clínica INDISA and Universidad Andrés Bello, Santiago, Chile.
authors.forename: Octavio A
authors.initials: OA
authors.lastname: Castillo
authors.affiliation: British and Austral Hospital, Buenos Aires, Argentina.
authors.forename: José J
authors.initials: JJ
authors.lastname: Rozanec
authors.affiliation: British and Austral Hospital, Buenos Aires, Argentina.
authors.forename: Marcelo
authors.initials: M
authors.lastname: Featherston
authors.affiliation: British and Austral Hospital, Buenos Aires, Argentina.
authors.forename: Pablo
authors.initials: P
authors.lastname: Holst
authors.affiliation: Urology Institute, Porto Alegre, Brazil.
authors.forename: José Cocisfran Alves
authors.initials: JC
authors.lastname: Milfont
authors.affiliation: Italian Hospital, Buenos Aires, Argentina.
authors.forename: Patricio
authors.initials: P
authors.lastname: García Marchiñena
authors.affiliation: Italian Hospital, Buenos Aires, Argentina.
authors.forename: Alberto
authors.initials: A
authors.lastname: Jurado Navarro
authors.affiliation: CEMIC University Hospital, Buenos Aires, Argentina.
authors.forename: Anamaría
authors.initials: A
authors.lastname: Autrán
authors.affiliation: CEMIC University Hospital, Buenos Aires, Argentina.
authors.forename: Agustín R
authors.initials: AR
authors.lastname: Rovegno
authors.affiliation: Puigvert Foundation, Barcelona, Spain.
authors.forename: Oscar Rodríguez
authors.initials: OR
authors.lastname: Faba
authors.affiliation: Puigvert Foundation, Barcelona, Spain.
authors.forename: Joan
authors.initials: J
authors.lastname: Palou
authors.affiliation: Urology Institute, Porto Alegre, Brazil.
authors.forename: Victor
authors.initials: V
authors.lastname: Teixeira Dubeux
authors.affiliation: Centro de Cirugía Robótica y de Invasión Mínima (C.I.M.I.), Caracas, Venezuela.
authors.forename: Luciano
authors.initials: L
authors.lastname: Nuñez Bragayrac
authors.affiliation: Centro de Cirugía Robótica y de Invasión Mínima (C.I.M.I.), Caracas, Venezuela.
authors.forename: Rene
authors.initials: R
authors.lastname: Sotelo
authors.affiliation: AC Camargo Cancer Center, São Paulo, Brazil.
authors.forename: Stenio
authors.initials: S
authors.lastname: Zequi
authors.affiliation: AC Camargo Cancer Center, São Paulo, Brazil.
authors.forename: Gustavo Cardoso
authors.initials: GC
authors.lastname: Guimarães
authors.affiliation: Infanta Sofía Hospital, Madrid, Spain.
authors.forename: Mario
authors.initials: M
authors.lastname: Álvarez-Maestro
authors.affiliation: Infanta Sofía Hospital, Madrid, Spain.
authors.forename: Luis
authors.initials: L
authors.lastname: Martínez-Piñeiro
authors.affiliation: Alexander Fleming Institute, Buenos Aires, Argentina.
authors.forename: Gustavo
authors.initials: G
authors.lastname: Villoldo
authors.affiliation: Alexander Fleming Institute, Buenos Aires, Argentina.
authors.forename: Alberto
authors.initials: A
authors.lastname: Villaronga
authors.affiliation: Pasteur Hospital, Montevideo, Uruguay.
authors.forename: Diego
authors.initials: D
authors.lastname: Abreu Clavijo
authors.affiliation: Pasteur Hospital, Montevideo, Uruguay.
authors.forename: Ricardo
authors.initials: R
authors.lastname: Decia
authors.affiliation: Quinta Dor and Samaritano Hospital, Rio de Janeiro, Brazil.
authors.forename: Rodrigo
authors.initials: R
authors.lastname: Frota
authors.affiliation: Clínica INDISA and Universidad Andrés Bello, Santiago, Chile.
authors.forename: Ivar
authors.initials: I
authors.lastname: Vidal-Mora
authors.affiliation: Hospital de Trauma Dr. F. Abete, Buenos Aires, Argentina.
authors.forename: Diana
authors.initials: D
authors.lastname: Finkelstein
authors.affiliation: Hospital de Trauma Dr. F. Abete, Buenos Aires, Argentina.
authors.forename: Juan I
authors.initials: JI
authors.lastname: Monzó Gardiner
authors.affiliation: Clínica INDISA and Universidad Andrés Bello, Santiago, Chile.
authors.forename: Oscar
authors.initials: O
authors.lastname: Schatloff
authors.affiliation: HoPe Urología, Tijuana, Mexico.
authors.forename: Andres
authors.initials: A
authors.lastname: Hernández-Porrás
authors.affiliation: La Raza Hospital, Mexico city, Mexico.
authors.forename: Félix
authors.initials: F
authors.lastname: Santaella-Torres
authors.affiliation: Mater Dei Hospital, Buenos Aires, Argentina.
authors.forename: Emilio T
authors.initials: ET
authors.lastname: Quesada
authors.affiliation: Hospital Universitario de Caracas, Caracas, Venezuela.
authors.forename: Rodolfo
authors.initials: R
authors.lastname: Sánchez-Salas
authors.affiliation: Hospital Universitario de Caracas, Caracas, Venezuela.
authors.forename: Hugo
authors.initials: H
authors.lastname: Dávila
authors.affiliation: Puigvert Foundation, Barcelona, Spain.
authors.forename: Humberto Villavicencio
authors.initials: HV
authors.lastname: Mavric
mesh_terms: D018249:Adenoma, Oxyphilic / Q000473:pathology / Q000601:surgery*; D000368:Aged; D018207:Angiomyolipoma / Q000473:pathology / Q000601:surgery*; D016063:Blood Loss, Surgical; D002292:Carcinoma, Renal Cell / Q000473:pathology / Q000601:surgery*; D061887:Conversion to Open Surgery; D016208:Databases, Factual; D005260:Female; D058733:Hand-Assisted Laparoscopy / Q000379:methods; D006801:Humans; D053208:Kaplan-Meier Estimate; D007680:Kidney Neoplasms / Q000473:pathology / Q000601:surgery*; D010535:Laparoscopy / Q000379:methods; D007902:Length of Stay / Q000706:statistics & numerical data; D016015:Logistic Models; D008297:Male; D000072662:Margins of Excision; D008800:Mexico; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000379:methods; D015999:Multivariate Analysis; D009367:Neoplasm Staging; D009392:Nephrectomy / Q000379:methods*; D061646:Operative Time; D011183:Postoperative Complications / Q000453:epidemiology*; D016016:Proportional Hazards Models; D065287:Robotic Surgical Procedures / Q000379:methods; D013020:South America; D013030:Spain; D047368:Tumor Burden; D052096:Warm Ischemia
keywords: Kidney cancer; Laparoscopy; Nephron sparing; Partial nephrectomy