title: Is Robotic Partial Nephrectomy Safe for T3a Renal Cell Carcinoma? Experience of a High-Volume Center.
abstract: To compare the oncological and functional outcomes of robotic partial nephrectomy (RPN) with radical nephrectomy (RN) in renal-cell carcinoma (RCC) cases with pT3a staging.
  
  
  
  A retrospective analysis of our IRB-approved nephrectomy database from 2005 to 2015 was performed. RPN and RN cases with confirmed RCC and pT3a staging were matched. Preoperative variables, functional, and oncological outcomes were compared between the groups, as well as Kaplan-Meier estimated overall survival (OS), cancer-specific survival (CSS), and recurrence-free survival (RFS). A multivariable Cox proportional hazards regression model for overall mortality rate was generated to evaluate hazard ratios (HRs) of potential risk factors.
  
  
  
  Seventy patients with pT3a tumors composed each group. Preoperative variables were comparable between groups. The median follow-up time for the cohort was 20 (9-38) months and the renal function preservation was higher in the RPN group (86% vs 70%; p < 0.001). The estimated 3 years of OS (90% vs 84%; p = 0.42), CSS (94% vs 95%; p = 0.78), and RFS (95% vs. 100%; p = 0.06) were similar between RPN and RN groups, respectively. On multivariable Cox regression model, the presence of ≥2 aggressive tumor features was the only factor associated with increased risk of overall mortality rate (HR 4.01 95% confidence interval [1.13, 14.27)]; p = 0.03).
  
  
  
  Patients with localized pT3a RCC treated with RPN had similar short-term oncological and better renal functional outcomes compared with similar cases treated by RN. In the minimally invasive robotic surgery era, renal masses suspicious for pathological T3a disease should not be a deterring factor for performing nephron-sparing surgery when technically feasible by skilled surgeons.
authors.affiliation: 1 Glickman Urological and Kidney Institute , Cleveland Clinic, Cleveland, Ohio.
authors.forename: Hiury S
authors.initials: HS
authors.lastname: Andrade
authors.affiliation: 1 Glickman Urological and Kidney Institute , Cleveland Clinic, Cleveland, Ohio.
authors.forename: Homayoun
authors.initials: H
authors.lastname: Zargar
authors.affiliation: 1 Glickman Urological and Kidney Institute , Cleveland Clinic, Cleveland, Ohio.
authors.forename: Oktay
authors.initials: O
authors.lastname: Akca
authors.affiliation: 1 Glickman Urological and Kidney Institute , Cleveland Clinic, Cleveland, Ohio.|2 Department of Urology, Amasya University Medical School , Amasya, Turkey .
authors.forename: Onder
authors.initials: O
authors.lastname: Kara
authors.affiliation: 1 Glickman Urological and Kidney Institute , Cleveland Clinic, Cleveland, Ohio.
authors.forename: Peter A
authors.initials: PA
authors.lastname: Caputo
authors.affiliation: 1 Glickman Urological and Kidney Institute , Cleveland Clinic, Cleveland, Ohio.
authors.forename: Daniel
authors.initials: D
authors.lastname: Ramirez
authors.affiliation: 1 Glickman Urological and Kidney Institute , Cleveland Clinic, Cleveland, Ohio.
authors.forename: Guillermo
authors.initials: G
authors.lastname: Andrés
authors.affiliation: 1 Glickman Urological and Kidney Institute , Cleveland Clinic, Cleveland, Ohio.
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Stein
authors.affiliation: 1 Glickman Urological and Kidney Institute , Cleveland Clinic, Cleveland, Ohio.
authors.forename: Shih-Chieh J
authors.initials: SJ
authors.lastname: Chueh
authors.affiliation: 1 Glickman Urological and Kidney Institute , Cleveland Clinic, Cleveland, Ohio.
authors.forename: Jihad H
authors.initials: JH
authors.lastname: Kaouk
mesh_terms: D000328:Adult; D000368:Aged; D002292:Carcinoma, Renal Cell / Q000401:mortality / Q000601:surgery*; D005260:Female; D006801:Humans; D007680:Kidney Neoplasms / Q000401:mortality / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009392:Nephrectomy / Q000379:methods*; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012307:Risk Factors; D065287:Robotic Surgical Procedures / Q000379:methods*; D016019:Survival Analysis
keywords: T3a renal cell carcinoma; minimally invasive surgery; oncology; outcomes; robotic partial nephrectomy