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Robot-Assisted Partial Nephrectomy for Totally Endophytic Renal Tumors: Step by Step Standardized Surgical Technique and Long-Term Outcomes with a Median 59-Month Follow-Up.

Authors
 Ali Abdel Raheem  ;  Ki Don Chang  ;  Mohammed Jayed Alenzi  ;  Trenton G. Lum  ;  Won Sik Ham  ;  Woong Kyu Han  ;  Byung Ha Chung  ;  Young Deuk Choi  ;  Koon Ho Rha 
Citation
 Journal of Laparoendoscopic & Advanced Surgical Techniques, Vol.29(1) : 1-11, 2019 
Journal Title
 Journal of Laparoendoscopic & Advanced Surgical Techniques 
ISSN
 1092-6429 
Issue Date
2019
Keywords
endophytic tumor ; partial nephrectomy ; robot assisted
Abstract
BACKGROUND: Treatment of totally endophytic renal tumors is a technically demanding surgery. While few studies show promising perioperative and short-term outcomes of robot-assisted partial nephrectomy (RAPN), its long-term outcomes remain undetermined. MATERIALS AND METHODS: A retrospective analysis of 89 patients with totally endophytic renal tumors undergoing either RAPN (n = 52) or open partial nephrectomy (OPN; n = 37) in a tertiary-care institution between 2005 and 2015 was performed. Primary endpoint was to describe our transperitoneal RAPN surgical technique, while secondary endpoint was to compare the 5-year chronic kidney disease (CKD)-free survival, cancer-specific survival (CSS), and metastasis-free survival (MFS) rates between RAPN and OPN. RESULTS: The median follow-up was 59 and 53 months for RAPN and OPN, respectively. Apart from increased prevalence of high complex tumors among RAPN cases (RAPN, 38.5% versus OPN, 16.2%; P = .037), and lower median eGFR (RAPN, 86 versus OPN 96 mL/minute/1.73 m2; P = .032), the remaining demographic characteristics were similar between the groups. At latest follow-up, the rates of local recurrence (P = .577), distant metastasis (P = .854), and cancer death (P = .187), and CKD upstaging ≥stage 3 (P = .728) did not differ between groups. The 5-year CKD upstaging-free survival was 96.2% versus 94.6% (log-rank, P = .746), MFS was 95.8% versus 97.1% (P = .876), and CSS was 100% versus 93.8% (log-rank, P = .102) when stratified by RAPN and OPN, respectively. CONCLUSION: RAPN is a safe and feasible option for treatment of totally endophytic renal tumors. Despite the increased prevalence of high tumor complexity and lower baseline renal function in the RAPN group, it achieved equivalent long-term oncologic control and functional outcome compared to OPN.
Full Text
https://www.liebertpub.com/doi/full/10.1089/lap.2018.0124
DOI
10.1089/lap.2018.0124
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/22282913/167548
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