title: Robotic and open partial nephrectomy for complex renal tumors: a matched-pair comparison with a long-term follow-up.
abstract: OBJECTIVE
  To compare the surgical, functional and oncological outcomes of patients undergoing robotic partial nephrectomy (RPN) or open partial nephrectomy (OPN) for moderately or highly complex tumors (RENAL nephrometry score ≥7).
  
  
  METHODS
  A retrospective, matched-pair analysis was performed for 380 patients who underwent either RPN (n = 190) or OPN (n = 190) for a complex renal mass in different institutions. Surgical data, pathological variables, complications and functional and oncological outcomes were reviewed.
  
  
  RESULTS
  RPN is associated with less estimated blood loss (EBL) (196.8 vs 240.8 ml; p < 0.001), shorter length of hospital stay (7.8 vs 9.2 days; p < 0.001) and lower rate of postoperative complications (15.8 vs 28.9 %; p = 0.002). Patients undergoing RPN required more direct cost. In multivariable models, surgical approach was the significant predictor for the occurrence of postoperative minor complications and postoperative wound pain. Median follow-up for RPN and OPN was 49 months and 52 months, respectively. The decline of estimated glomerular filtration at the last available follow-up (RPN: 8.7 %; OPN: 10 %) was similar (p = 0.125). The 5-year recurrence-free survival rate was 95.1 % for RPN and 92.7 % for OPN (p = 0.48).
  
  
  CONCLUSIONS
  RPN provides acceptable and comparable results in terms of perioperative, functional and oncological outcomes compared to OPN for complex renal tumors with RENAL score ≥7. Moreover, RPN is a less invasive approach with the benefit of shorter length of hospital stay, less EBL and lower rate of postoperative complications.
authors.affiliation: Department of Urology, Shanxi Provincial People's Hospital, Taiyuan, 030001, China.
authors.forename: Yubin
authors.initials: Y
authors.lastname: Wang
authors.affiliation: Department of Urology, Shanxi Provincial People's Hospital, Taiyuan, 030001, China.
authors.forename: Jinkai
authors.initials: J
authors.lastname: Shao
authors.affiliation: Department of Urology, Chinese People's Liberation Army General Hospital, 28 Fuxing Road, Beijing, 100853, People's Republic of China.
authors.forename: Xin
authors.initials: X
authors.lastname: Ma
authors.affiliation: Department of Urology, Chinese People's Liberation Army General Hospital, 28 Fuxing Road, Beijing, 100853, People's Republic of China.
authors.forename: Qingshan
authors.initials: Q
authors.lastname: Du
authors.affiliation: Department of Urology, Chinese People's Liberation Army General Hospital, 28 Fuxing Road, Beijing, 100853, People's Republic of China.
authors.forename: Huijie
authors.initials: H
authors.lastname: Gong
authors.affiliation: Department of Urology, Chinese People's Liberation Army General Hospital, 28 Fuxing Road, Beijing, 100853, People's Republic of China. xuzhang301@126.com.
authors.forename: Xu
authors.initials: X
authors.lastname: Zhang
mesh_terms: D000231:Adenocarcinoma, Papillary / Q000473:pathology / Q000601:surgery*; D000368:Aged; D016063:Blood Loss, Surgical; D002292:Carcinoma, Renal Cell / Q000473:pathology / Q000601:surgery*; D016022:Case-Control Studies; D016208:Databases, Factual; D018572:Disease-Free Survival; D005260:Female; D017048:Health Care Costs; D006801:Humans; D007680:Kidney Neoplasms / Q000473:pathology / Q000601:surgery*; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009392:Nephrectomy / Q000191:economics / Q000379:methods*; D061646:Operative Time; D010149:Postoperative Pain / Q000453:epidemiology; D011183:Postoperative Complications / Q000453:epidemiology; D012189:Retrospective Studies; D065287:Robotic Surgical Procedures / Q000191:economics / Q000379:methods*
keywords: Partial nephrectomy; RENAL nephrometry score; Renal cell carcinoma; Robotics