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Oncologic Efficacy of Laparoscopic and Robotic Partial Nephrectomy Compared to Open Partial Nephrectomy for Renal Tumors ≥ T1b
Kyle T. Finnegan, BS, Steven J. Shichman, MD, Joseph R. Wagner, MD, Stuart S. Kesler, MD, Anoop M. Meraney, MD.
Hartford Hospital, Hartford, CT, USA.

Background: Minimally invasive partial nephrectomy is an established treatment option for renal tumors <4 cm (pT1a). Oncologic outcomes for renal tumors, ≥ T1b treated using minimally invasive surgical techniques remains to be evaluated. In this study, we evaluate the oncologic outcomes of renal tumors staged pT1b or greater treated using laparoscopic (LPN) and robotic partial nephrectomy (RPN) compared to open partial nephrectomy (OPN) at a single institution.

Methods: 35 patients underwent LPN and RPN for ≥ T1b tumors from October 2003 - August 2009 (group 1), and 36 patients underwent OPN for ≥ T1b tumors from July 1999 - June 2009 (group 2). Tumors were excised utilizing either minimally invasive techniques or open surgically at the discretion of the operating surgeon. Perioperative data, complications, tumor pathology and follow-up patient information were prospectively collected into an IRB-approved database.

Results: Comparing Group 1 to group 2, the length of stay was significantly shorter, 3.8 vs. 5.5 days (p<0.001) and there were fewer complications 4 vs. 10 (11.4% vs. 27.8%). There were no significant differences in operative time, (233.4 vs.232.1 mins), estimated blood loss, (531.8 vs. 545.8 mL) and warm ischemic time, (33.8 vs. 36.3 mins) for group 1 vs. group 2. Within group 1, tumor pathology was 60.0% clear cell, 37.1% papillary, and 2.9% chromophobe. Pathologic tumor stage for patients within group 1 were as follows: 74.3% T1b, 5.7% T2, 17.1% T3a, and 2.9% T3b. Withiin group 2, tumor pathology was 55.5% clear cell, 25.0% papillary, 13.9% chromophobe, and 5.6% unclassified. Pathologic tumor stage for patients within group 2 were as follows: 61.1% T1b, 19.4% T2, 16.7% T3a, and 2.8% T3b. Preservation of renal function was also similar between the two groups, the 4-month average drop in GFR by the MDRD equation was 15.1% in group 1 and 13.7% in group 2. There were no local recurrences and 1 case of metastatic disease (bone) after an average follow-up of 21.2 months in group 1. There have been 4 local recurrences and 2 cases of metastatic disease (bone, chest) after an average follow-up of 42.0 months in group 2. Cancer Specific and overall survival are both 100% in group 1. Cancer specific survival is 94.4% and overall survival 83.3% in group 2.

Conclusions: Laparoscopic and robotic partial nephrectomy for renal tumors stage pT1b or greater is associated with oncologic outcomes comparable to open partial nephrectomy. Comparable preservation of renal function can also be achieved following minimally invasive partial nephrectomy for ≥ T1b renal tumors.


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