title: Renal functional outcomes after robotic multiplex partial nephrectomy: the National Cancer Institute experience with robotic partial nephrectomy for 3 or more tumors in a single kidney.
abstract: OBJECTIVE
  To identify renal function outcomes after robotic multiplex partial nephrectomy (RMxPNx), we reviewed our institutional database at the National Institutes of Health, National Cancer Institute. To our knowledge, we present the largest series of RMxPNx renal function outcomes to date. Robotic partial nephrectomy has been employed for oncologic control and to prevent dialysis dependence in hereditary multifocal renal cell carcinoma conditions. We have termed robotic surgery on a single kidney with three or more lesions a RMxPNx.
  
  
  METHODS
  We evaluated patients from a prospectively maintained database at a single institution (NIH/NCI) that underwent RMxPNx from 2007 to 2013. Demographic and operative data were compiled with statistical analysis with T test performed to determine renal function outcomes.
  
  
  RESULTS
  A total of 54 patients underwent RMxPNx. Mean number of tumors removed was 8.63 (range 3-52). Mean preoperative creatinine and eGFR were 1.02 ± 0.26 mg/dL and 85.4 ± 21.5 mL/min, respectively. Postoperatively, creatinine increased from baseline by 0.45 mg/dL (p < 0.001). Similarly, a mean decrease in eGFR by 24.6 mL/min was observed (p < 0.001). At 3-month follow-up, the creatinine increase from baseline was 0.05 mg/dL (p = 0.10) and mean decrease in eGFR was 3.01 mL/min (p = 0.21). When stratifying based on preoperative CKD stages I-III, similar results were observed.
  
  
  CONCLUSIONS
  Robotic multiplex partial nephrectomy is a safe and feasible approach to patients with multifocal renal masses. These complex surgeries have a demonstrated learning curve, but this minimally invasive approach for nephron-sparing surgery allows patients to preserve renal function where they would otherwise require open surgery or a radical nephrectomy.
authors: Urologic Oncology Branch, Center for Cancer Research, National Cancer Institute, Building 10, Room 2 W-5940, 10 Center Drive, MSC 1210, Bethesda, MD, 20892, USA.
authors: Ryan A
authors: RA
authors: Hankins
authors: Urologic Oncology Branch, Center for Cancer Research, National Cancer Institute, Building 10, Room 2 W-5940, 10 Center Drive, MSC 1210, Bethesda, MD, 20892, USA.
authors: Annerleim
authors: A
authors: Walton-Diaz
authors: Urologic Oncology Branch, Center for Cancer Research, National Cancer Institute, Building 10, Room 2 W-5940, 10 Center Drive, MSC 1210, Bethesda, MD, 20892, USA.
authors: Hong
authors: H
authors: Truong
authors: Urologic Oncology Branch, Center for Cancer Research, National Cancer Institute, Building 10, Room 2 W-5940, 10 Center Drive, MSC 1210, Bethesda, MD, 20892, USA.
authors: Joanna
authors: J
authors: Shih
authors: Urologic Oncology Branch, Center for Cancer Research, National Cancer Institute, Building 10, Room 2 W-5940, 10 Center Drive, MSC 1210, Bethesda, MD, 20892, USA.
authors: Gennady
authors: G
authors: Bratslavsky
authors: Urologic Oncology Branch, Center for Cancer Research, National Cancer Institute, Building 10, Room 2 W-5940, 10 Center Drive, MSC 1210, Bethesda, MD, 20892, USA.
authors: Peter A
authors: PA
authors: Pinto
authors: Urologic Oncology Branch, Center for Cancer Research, National Cancer Institute, Building 10, Room 2 W-5940, 10 Center Drive, MSC 1210, Bethesda, MD, 20892, USA.
authors: W
authors: W
authors: Marston Linehan
authors: Urologic Oncology Branch, Center for Cancer Research, National Cancer Institute, Building 10, Room 2 W-5940, 10 Center Drive, MSC 1210, Bethesda, MD, 20892, USA. adam.metwalli@nih.gov.
authors: Adam R
authors: AR
authors: Metwalli
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002292:Carcinoma, Renal Cell / Q000473:pathology / Q000503:physiopathology* / Q000601:surgery; D003404:Creatinine / Q000097:blood; D005260:Female; D005500:Follow-Up Studies; D005919:Glomerular Filtration Rate; D006801:Humans; D007680:Kidney Neoplasms / Q000473:pathology / Q000503:physiopathology* / Q000601:surgery; D008297:Male; D008875:Middle Aged; D054547:National Cancer Institute (U.S.); D009378:Neoplasms, Multiple Primary / Q000473:pathology / Q000503:physiopathology* / Q000601:surgery; D009392:Nephrectomy / Q000379:methods*; D011184:Postoperative Period; D057234:Preoperative Period; D012189:Retrospective Studies; D065287:Robotic Surgical Procedures; D014481:United States; D055815:Young Adult
chemical_list: D003404:Creatinine
keywords: Kidney cancer; Multifocal renal tumors; Multiplex partial nephrectomy; Partial nephrectomy; Robotic surgery