Robotic and open partial nephrectomy for localized renal tumors larger than 7 cm: a single-center experience.
OBJECTIVE
To compare perioperative outcomes between robotic partial nephrectomy and open partial nephrectomy for localized >7 cm tumors.


METHODS
We identified patients in our institutional review boards approved database who underwent robotic partial nephrectomy or open partial nephrectomy for treatment of renal tumors >7 cm in size between January 2009 and August 2015. The operative-postoperative outcomes and complications were compared between groups.


RESULTS
The number of patients with >7 cm renal tumors treated at our center with robotic partial nephrectomy and open partial nephrectomy were 54 and 56, respectively. Patients' demographics and tumor characteristics were similar between groups. Likewise, there were no significant difference between the groups in duration of operation, positive surgical margin rates and incidence of malignant disease rates. Median ischemia time was lower in robotic partial nephrectomy group (31.5 vs. 35 min., p = 0.02). Patients undergoing robotic partial nephrectomy had significantly lower intraoperative blood transfusion rates (9.4 vs. 30.4 %, p = 0.008) and shorter length of hospital stay (3.5 vs. 5.3 days, p < 0.001). The incidence of overall complications (robotic arm, 18.5 % vs. open arm, 28.6 %, p = 0.26) and major complications (robotic arm, 3.7 % vs. open arm, 12.5 %, p = 0.16) was comparable between the two groups. The readmission rate within 30-days after discharge was higher in open partial nephrectomy group (p = 0.03). There was no difference in the median percentage estimated glomerular filtration rate preservation and chronic kidney disease upstaging between groups.


CONCLUSIONS
Localized renal tumors >7 cm and amenable to partial nephrectomy can be considered suitable for robotic approach.
Department of Urology, Glickman Urological and Kidney Institute, Cleveland Clinic, 9500 Euclid Ave., Q10-1, Cleveland, OH, 44195, USA.|Urology Department, University of Health Science, Sultan Abdulhamid Education and Training Hospital, Istanbul, Turkey.
Ercan
E
Malkoc
Department of Urology, Glickman Urological and Kidney Institute, Cleveland Clinic, 9500 Euclid Ave., Q10-1, Cleveland, OH, 44195, USA.
Daniel
D
Ramirez
Department of Urology, Glickman Urological and Kidney Institute, Cleveland Clinic, 9500 Euclid Ave., Q10-1, Cleveland, OH, 44195, USA.|Urology Department, Amasya University Medical School, Amasya, Turkey.
Onder
O
Kara
Department of Urology, Glickman Urological and Kidney Institute, Cleveland Clinic, 9500 Euclid Ave., Q10-1, Cleveland, OH, 44195, USA.
Matthew J
MJ
Maurice
Department of Urology, Glickman Urological and Kidney Institute, Cleveland Clinic, 9500 Euclid Ave., Q10-1, Cleveland, OH, 44195, USA.
Ryan J
RJ
Nelson
Department of Urology, Glickman Urological and Kidney Institute, Cleveland Clinic, 9500 Euclid Ave., Q10-1, Cleveland, OH, 44195, USA.
Peter A
PA
Caputo
Department of Urology, Glickman Urological and Kidney Institute, Cleveland Clinic, 9500 Euclid Ave., Q10-1, Cleveland, OH, 44195, USA. kaoukj@ccf.org.
Jihad H
JH
Kaouk
D000368:Aged; D002292:Carcinoma, Renal Cell / Q000473:pathology / Q000601:surgery*; D050377:Cold Ischemia; D016208:Databases, Factual; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D015994:Incidence; D007680:Kidney Neoplasms / Q000473:pathology / Q000601:surgery*; D007902:Length of Stay; D008297:Male; D000072662:Margins of Excision; D008875:Middle Aged; D009367:Neoplasm Staging; D009392:Nephrectomy / Q000379:methods*; D010359:Patient Readmission / Q000706:statistics & numerical data; D011183:Postoperative Complications / Q000453:epidemiology*; D051436:Renal Insufficiency, Chronic / Q000453:epidemiology*; D012189:Retrospective Studies; D065287:Robotic Surgical Procedures / Q000379:methods*; D012720:Severity of Illness Index; D047368:Tumor Burden; D052096:Warm Ischemia
Larger than 7 cm kidney tumor; Nephrectomy; Partial nephrectomy; Perioperative outcomes; Robotic surgical procedures
Eur Urol. 2015 May;67(5):913-24
25616710
Med Care. 2015 Jan;53(1):71-8
25494234
Urology. 2014 Sep;84(3):602-8
24929947
J Urol. 2010 Mar;183(3):903-8
20083271
J Urol. 2013 Apr;189(4):1229-35
23085300
Ann Intern Med. 1999 Mar 16;130(6):461-70
10075613
Int J Clin Oncol. 2015 Aug;20(4):808-13
25614490
Eur Urol. 2011 Aug;60(2):241-8
21458155
BJU Int. 2012 May;109(10):1450-6
22221502
Eur Urol. 2012 Sep;62(3):553-61
22658759
BJU Int. 2010 Nov;106(10):1484-7
20518765
Korean J Urol. 2015 Nov;56(11):742-8
26568791
Curr Urol Rep. 2016 Jan;17(1):5
26715221
J Urol. 2013 Aug;190(2):407-16
23665399
Urology. 2015 Aug;86(2):312-9
26189330
Eur Urol. 2011 Jun;59(6):931-7
21371812
Ann Intern Med. 2003 Jul 15;139(2):137-47
12859163
J Urol. 2009 Jan;181(1):35-41
19012929
J Urol. 2010 Feb;183(2):473-9
20006866
J Urol. 2009 Oct;182(4):1271-9
19683266
Eur Urol. 2008 Jul;54(1):143-49
18407401
J Urol. 2007 Nov;178(5):2109-13; discussion 2113
17870127
Lancet Oncol. 2006 Sep;7(9):735-40
16945768
Semin Urol Oncol. 1995 Nov;13(4):281-7
8595552
Ann Surg. 2004 Aug;240(2):205-13
15273542
Urol Oncol. 2007 Jul-Aug;25(4):298-302
17628295
Urol Oncol. 2013 Jan;31(1):51-6
21292511
Urol Int. 2004;72(1):13-6
14730159
BJU Int. 2016 Mar;117(3):531-6
26435486