title: Outcomes of Minimal Invasive vs Open Radical Nephrectomy for the Treatment of Locally Advanced Renal-Cell Carcinoma.
abstract: We compare oncologic outcomes of minimally invasive and open nephrectomy for locally advanced kidney cancer.
  
  
  
  A retrospective review of a single-institutional, prospectively maintained database from a National Comprehensive Cancer Network-designated center was conducted. All patients who underwent radical nephrectomy at Roswell Park Cancer Institute with diagnosis of pT3 and pT4 renal-cell carcinoma (RCC) between years 1998 and 2015 were reviewed. Patients who underwent partial nephrectomy and nephroureterectomy were excluded.
  
  
  
  We identified 172 patients with pT3 or pT4 tumors resected by minimally invasive (laparoscopic and robotic) or open radical nephrectomy. Demographic characteristics were similar between the two groups. Patients in the minimally invasive group had a higher mean body mass index (31.9 vs 28.1, p = 0.002), radiologically smaller tumors (7.7 cm vs 9.1 cm, p = 0.008), lower mean estimated blood loss (277 vs 1429, p < 0.001), lower rate of blood transfusion (4.7% vs 45.5%, p < 0.001), and a shorter mean length of stay (3.5 days vs 5.7 days, p < 0.001) compared with patients who underwent open surgery. At a median follow-up of 32.8 months, there was no significant difference in overall survival (p = 0.8) between the two groups.
  
  
  
  Minimal invasive nephrectomy is a safe approach with similar oncologic outcomes to open nephrectomy for select patients with locally advanced RCC.
authors.affiliation: 1 Department of Urology, Roswell Park Cancer Institute , Buffalo, New York.
authors.forename: Luciano A Nunez
authors.initials: LA
authors.lastname: Bragayrac
authors.affiliation: 1 Department of Urology, Roswell Park Cancer Institute , Buffalo, New York.
authors.forename: Daniel
authors.initials: D
authors.lastname: Abbotoy
authors.affiliation: 2 Department of Biostatistics & Bioinformatics, Roswell Park Cancer Institute , Buffalo, New York.
authors.forename: Kristopher
authors.initials: K
authors.lastname: Attwood
authors.affiliation: 1 Department of Urology, Roswell Park Cancer Institute , Buffalo, New York.
authors.forename: Fadi
authors.initials: F
authors.lastname: Darwiche
authors.affiliation: 3 Otto von Guericke Universität Magdeburg , Magdeburg, Germany .
authors.forename: Jan
authors.initials: J
authors.lastname: Hoffmeyer
authors.affiliation: 1 Department of Urology, Roswell Park Cancer Institute , Buffalo, New York.
authors.forename: Eric C
authors.initials: EC
authors.lastname: Kauffman
authors.affiliation: 1 Department of Urology, Roswell Park Cancer Institute , Buffalo, New York.
authors.forename: Thomas
authors.initials: T
authors.lastname: Schwaab
mesh_terms: D016063:Blood Loss, Surgical; D001803:Blood Transfusion; D002292:Carcinoma, Renal Cell / Q000473:pathology / Q000601:surgery*; D016208:Databases, Factual; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D007680:Kidney Neoplasms / Q000473:pathology / Q000601:surgery*; D010535:Laparoscopy; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009392:Nephrectomy / Q000379:methods*; D012189:Retrospective Studies; D065287:Robotic Surgical Procedures; D015996:Survival Rate; D014513:Ureter / Q000601:surgery*