title: Parcial Nephrectomies - results of 12 years from an Oncology Institution.
abstract: BACKGROUND
  The diagnosis of renal cell carcinoma has been increasing in recent years, especially due to incidental cases, and thus indication for nephron-preserving surgery has also risen.
  
  
  OBJECTIVE
  To review a series of partial nephrectomies from an oncology institution namely technique features, survival and change in renal function.
  
  
  METHODS
  A retrospective analysis of all patients with renal tumors that were submitted to partial nephrectomy at our institution between January 2000 and December 2012.
  
  
  RESULTS
  A total 156 partial nephrectomies were performed, 85 in men and 71 in women, with mean overall age of 62 '± 15 years. Surgical approach was transperitoneal laparoscopic in 23 cases with the remainder 133 through lumbotomy. Mean ischemic time was < 25 min in all patients and complication rate was 10.9 %, mostly corresponding grade 2 and 3 of the Clavien-Dindo scale. Mean tumor size was 2.9 '± 1.4 cm and the surgical margin was focally affected by tumor in 9.6% of cases. Histologically, 26.2% of cases corresponded to clear cell renal cell carcinoma, with oncocytomas being the most common benign neoplasm with 14.7% of the total. There were 4 cases of recurrence and one case death at follow-up. The mean change in estimated glomerular filtration rate was -5.3 mL/min per 1.73 m2 (p < 0.001). There was no association between warm ischemia time, body mass index, age, ASA score, presence of complications with this decrease in glomerular filtration rate.
  
  
  CONCLUSIONS
  Our positive surgical margins cases were slightly above what is described in literature, however we didn't find any predictive factor for such finding and ultimately there was no evidence of tumor recurrence or influence in survival in all these cases. Even though there was a significant decrease in estimated glomerular filtration rate, warm ischemia time was very low and only five patients presented with de novo eGFR < 60 mL/min per 1.73 m2, and two patients started hemodialysis. A high volume center seems to be critical for technique optimization and complication management.
  
  
  CONCLUSIONS
  Our series of partial nephrectomies presents oncological results and preservation of renal function similar to those published in literature. This is a safe technique with good results, justifying its growth.
authors.affiliation: Serviço de Urologia. Instituto Português de Oncologia Francisco Gentil. Porto.
authors.forename: Rui
authors.initials: R
authors.lastname: Freitas
authors.affiliation: Serviço de Urologia. Instituto Português de Oncologia Francisco Gentil. Porto.
authors.forename: Ricardo
authors.initials: R
authors.lastname: Cruz
authors.affiliation: Serviço de Epidemiologia. Instituto Português de Oncologia Francisco Gentil. Porto.
authors.forename: Luís
authors.initials: L
authors.lastname: Antunes
authors.affiliation: Serviço de Urologia. Instituto Português de Oncologia Francisco Gentil. Porto.
authors.forename: Paulo
authors.initials: P
authors.lastname: Araújo
authors.affiliation: Serviço de Urologia. Instituto Português de Oncologia Francisco Gentil. Porto.
authors.forename: Pedro
authors.initials: P
authors.lastname: Silva
authors.affiliation: Serviço de Urologia. Instituto Português de Oncologia Francisco Gentil. Porto.
authors.forename: Luis
authors.initials: L
authors.lastname: Saraiva
authors.affiliation: Serviço de Urologia. Instituto Português de Oncologia Francisco Gentil. Porto.
authors.forename: Sanches
authors.initials: S
authors.lastname: Magalhães
authors.affiliation: Serviço de Urologia. Instituto Português de Oncologia Francisco Gentil. Porto.
authors.forename: Vitor
authors.initials: V
authors.lastname: Moreira Silva
authors.affiliation: Serviço de Urologia. Instituto Português de Oncologia Francisco Gentil. Porto.
authors.forename: António
authors.initials: A
authors.lastname: Morais
authors.affiliation: Serviço de Urologia. Instituto Português de Oncologia Francisco Gentil. Porto.
authors.forename: Francisco
authors.initials: F
authors.lastname: Lobo
authors.affiliation: Serviço de Urologia. Instituto Português de Oncologia Francisco Gentil. Porto.
authors.forename: Jorge
authors.initials: J
authors.lastname: Oliveira
mesh_terms: D002173:Cancer Care Facilities; D005260:Female; D006801:Humans; D007668:Kidney / Q000503:physiopathology / Q000601:surgery; D007677:Kidney Function Tests; D007680:Kidney Neoplasms / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009392:Nephrectomy / Q000379:methods*; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome