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Functional and oncological outcomes of open, laparoscopic and robot-assisted partial nephrectomy: a multicentre comparative matched-pair analyses with a median of 5 years' follow-up.

Authors
 Ki Don Chang  ;  Ali Abdel Raheem  ;  Kwang Hyun Kim  ;  Cheol Kyu Oh  ;  Sung Yul Park  ;  Young Sik Kim  ;  Won Sik Ham  ;  Woong Kyu Han  ;  Young Deuk Choi  ;  Byung Ha Chung  ;  Koon Ho Rha 
Citation
 BJU International, Vol.122(4) : 618-626, 2018 
Journal Title
 BJU International 
ISSN
 1464-4096 
Issue Date
2018
Keywords
laparoscopic ; long-term outcomes ; open ; partial nephrectomy ; robot-assisted
Abstract
OBJECTIVES: To compare outcomes at a 5-year median follow-up among different partial nephrectomy (PN) approaches: robot-assisted (RAPN), laparoscopic (LPN) and open partial nephrectomy (OPN). PATIENTS AND METHODS: We retrospectively analysed 1 308 patients who underwent PN (RAPN, n = 380; LPN, n = 206; OPN, n = 722) between 2006 and 2012 at one of four academic centres. We performed 1:1:1 propensity-score-matching adjustment based on confounding variables among groups, and 366 patients (122 in each group) were included in the final analysis. Survival rates were analysed using the Kaplan-Meier method. RESULTS: The median follow-up periods were 60, 59.8 and 64.1 months for RAPN, LPN and OPN, respectively. In the matched groups, RAPN resulted in significantly lower mean estimated blood loss compared with LPN (P = 0.025) and OPN (P = 0.040), while LPN was associated with a longer mean operating time compared with RAPN (P = 0.001) and OPN (P = 0.001). The hospital stay was shorter in the RAPN group (P = 0.008). Regarding the oncological outcomes, there were no significant differences among the three groups in local recurrence rate (P = 0.882), distant metastasis rate (P = 0.816) or deaths from cancer (P = 0.779). At latest follow-up, the incidence of chronic kidney disease (CKD) upstaging was significantly lower in RAPN compared with LPN (20.55% vs 32%; P = 0.035) and OPN (20.5% vs 33.6%; P = 0.038). The 5-year CKD free-survival rate was significantly higher (78.4%) in the RAPN group compared with 58.8% and 65.8% in the LPN and OPN groups, respectively (log-rank P = 0.031). CONCLUSIONS: In the present study, RAPN, LPN and OPN had similar local recurrence, distant metastasis and cancer-related death rates at a 5-year median follow-up. In terms of functional outcomes, RAPN was associated with a lower incidence of CKD upstaging compared with OPN and LPN.
Full Text
https://onlinelibrary.wiley.com/doi/full/10.1111/bju.14250
DOI
10.1111/bju.14250
Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Urology (비뇨의학교실) > 1. Journal Papers
Yonsei Authors
나군호(Rha, Koon Ho) ORCID logo https://orcid.org/0000-0001-8588-7584
정병하(Chung, Byung Ha) ORCID logo https://orcid.org/0000-0001-9817-3660
최영득(Choi, Young Deuk) ORCID logo https://orcid.org/0000-0002-8545-5797
한웅규(Han, Woong Kyu) ORCID logo https://orcid.org/0000-0002-2527-4046
함원식(Ham, Won Sik) ORCID logo https://orcid.org/0000-0003-2246-8838
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URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/165155
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