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R-LESS Partial Nephrectomy Trifecta Outcome Is Inferior to Multiport Robotic Partial Nephrectomy: Comparative Analysis

Authors
 Christos Komninos  ;  Tae Young Shin  ;  Patrick Tuliao  ;  Young Eun Yoon  ;  Kyo Chul Koo  ;  Chien-Hsiang Chang  ;  Sang Woon Kim  ;  Ji Yong Ha  ;  Woong Kyu Han  ;  Koon Ho Rha 
Citation
 EUROPEAN UROLOGY, Vol.66(3) : 512-517, 2014 
Journal Title
 EUROPEAN UROLOGY 
ISSN
 0302-2838 
Issue Date
2014
MeSH
Adult ; Aged ; Blood Loss, Surgical ; Carcinoma, Renal Cell/pathology ; Carcinoma, Renal Cell/surgery* ; Female ; Glomerular Filtration Rate ; Humans ; Kidney Neoplasms/pathology ; Kidney Neoplasms/surgery* ; Laparoscopy/adverse effects ; Laparoscopy/methods* ; Length of Stay ; Male ; Middle Aged ; Neoplasm, Residual ; Nephrectomy/adverse effects ; Nephrectomy/methods* ; Operative Time ; Retrospective Studies ; Robotic Surgical Procedures/adverse effects ; Robotic Surgical Procedures/methods* ; Tumor Burden ; Warm Ischemia*
Keywords
Laparoendoscopic single-site ; Partial nephrectomy ; Renal cell carcinoma ; Robotic surgery
Abstract
BACKGROUND: Trifecta achievement in partial nephrectomy (PN) is defined as the combination of warm ischemia time ≤ 20 min, negative surgical margins, and no surgical complications. OBJECTIVE: To compare trifecta achievement between robotic, laparoendoscopic, single-site (R-LESS) PN and multiport robotic PN (RPN). DESIGN, SETTING, AND PARTICIPANTS: Data from 167 patients who underwent RPN from 2006 to 2012 were retrospectively analyzed. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: Primary outcome measurement was trifecta achievement; secondary outcome was the perioperative and postoperative comparison between groups. The measurements were estimated and analyzed with SPSS v.18 using univariable, multivariable, and subgroup analyses. RESULTS AND LIMITATIONS: Eighty-nine patients were treated with RPN and 78 were treated with R-LESS PN. Baseline characteristics of both groups were similar. Trifecta was achieved in 38 patients (42.7%) in the multiport RPN group and 20 patients (25.6%) in the R-LESS PN group (p=0.021). Patients in the R-LESS PN group had longer mean operative time, warm ischemia time, and increased estimated glomerular filtration rate (eGFR) percentage change. No significant differences were found between the two groups in days of hospitalization, blood loss, postoperative eGFR, positive surgical margins, and surgical complications. Patients with increased PADUA and RENAL scores, infiltration of the collecting system, and renal sinus involvement had an increased probability of not achieving the trifecta. In regression analysis, the type of procedure and the tumor size could predict trifecta accomplishment (p=0.019 and 0.043, respectively). The retrospective study, the low number of series, and the controversial definition of trifecta were the main limitations. CONCLUSIONS: The trifecta was achieved in significantly more patients who underwent multiport RPN than those who underwent R-LESS PN. R-LESS PN could be an alternative option for patients with decreased tumor size, low PADUA and RENAL scores, and without renal sinus or collecting system involvement. PATIENT SUMMARY: In this study, we looked at the outcomes of patients who had undergone robotic partial nephrectomy. We found that conventional robotic partial nephrectomy is superior to R-LESS partial nephrectomy with regard to the accomplishment of negative margins, reduced warm ischemia time, and minimal surgical complications.
Full Text
http://www.sciencedirect.com/science/article/pii/S0302283813011962
DOI
10.1016/j.eururo.2013.10.058
Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Urology (비뇨의학교실) > 1. Journal Papers
Yonsei Authors
Koo, Kyo Chul(구교철) ORCID logo https://orcid.org/0000-0001-7303-6256
Kim, Sang Woon(김상운) ORCID logo https://orcid.org/0000-0002-5790-1948
Rha, Koon Ho(나군호) ORCID logo https://orcid.org/0000-0001-8588-7584
Shin, Tae Young(신태영)
Yoon, Young Eun(윤영은)
Komninos, Christos(크리스토스콤니노스)
Tuliao, Patrick(툴리아오패트릭)
Ha, Ji Yong(하지용)
Han, Woong Kyu(한웅규) ORCID logo https://orcid.org/0000-0002-2527-4046
URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/100160
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