TY - JOUR
T1 - Five-year Oncologic Outcomes after Transperitoneal Robotic Partial Nephrectomy for Renal Cell Carcinoma
AU - Andrade, Hiury S.
AU - Zargar, Homayoun
AU - Caputo, Peter A.
AU - Akca, Oktay
AU - Kara, Onder
AU - Ramirez, Daniel
AU - Haber, Georges Pascal
AU - Stein, Robert J.
AU - Kaouk, Jihad H.
N1 - Publisher Copyright:
© 2015 European Association of Urology.
PY - 2016/6/1
Y1 - 2016/6/1
N2 - Background Robotic partial nephrectomy (RPN) is established as a minimally invasive nephron-sparing technique with excellent perioperative and intermediate oncologic outcomes. However, long-term oncologic outcomes have not been reported to date. Objective To report long-term oncologic outcomes of RPN. Design, setting, and participants Consecutive patients undergoing RPN from June 2006 to March 2010 were selected from our prospective RPN database. Patients with benign tumors, prior ipsilateral PN, or prior radical nephrectomy and those with follow-up of <1 mo were excluded. Intervention Transperitoneal RPN. Outcomes measurements and statistical analysis Demographic, perioperative, and postoperative data were analyzed. Overall survival (OS), cancer-free survival (CFS), and cancer-specific survival (CSS) were evaluated using Kaplan-Meier survival analysis. Univariate logistic regression analysis for overall mortality was performed to evaluate the odds ratio (OR) for variables of interest. Results and limitations In total, 115 RPNs for RCC were performed in 110 patients. The mean age was 59.8 ± 11.0 yr and the median age-adjusted Charlson comorbidity index (ACCI) was 4 (interquartile range [IQR] 3-5). The median tumor size was 2.6 cm (IQR 2.0-3.7) and median RENAL score was 7 (IQR 6-9). Clear cell carcinoma was present in 67.8% of cases, and two cases (1.7%) had positive surgical margins. Glomerular filtration rate preservation was 87.8% (IQR 74.9-98.1), which translates to 19.1% chronic kidney disease upstaging. The median follow-up was 61.9 mo (IQR 50.9-71.4) and the 5-yr OS, CFS, and CSS were 91.1%, 97.8%, and 97.8%, respectively. On univariable logistic regression, ACCI was the only factor associated with a higher risk of overall mortality (OR 1.67, p = 0.006). The retrospective design, the high surgical volume at our institution, and the potential selection bias with careful patient selection early in the RPN experience may limit the generalizability of our findings. Conclusions This is the first study confirming excellent long-term oncologic outcomes after RPN in a selected cohort of patients. Patient summary Robotic partial nephrectomy is a relatively recently developed treatment for renal cell carcinoma. This study confirms its safety and reports excellent long-term cancer control.
AB - Background Robotic partial nephrectomy (RPN) is established as a minimally invasive nephron-sparing technique with excellent perioperative and intermediate oncologic outcomes. However, long-term oncologic outcomes have not been reported to date. Objective To report long-term oncologic outcomes of RPN. Design, setting, and participants Consecutive patients undergoing RPN from June 2006 to March 2010 were selected from our prospective RPN database. Patients with benign tumors, prior ipsilateral PN, or prior radical nephrectomy and those with follow-up of <1 mo were excluded. Intervention Transperitoneal RPN. Outcomes measurements and statistical analysis Demographic, perioperative, and postoperative data were analyzed. Overall survival (OS), cancer-free survival (CFS), and cancer-specific survival (CSS) were evaluated using Kaplan-Meier survival analysis. Univariate logistic regression analysis for overall mortality was performed to evaluate the odds ratio (OR) for variables of interest. Results and limitations In total, 115 RPNs for RCC were performed in 110 patients. The mean age was 59.8 ± 11.0 yr and the median age-adjusted Charlson comorbidity index (ACCI) was 4 (interquartile range [IQR] 3-5). The median tumor size was 2.6 cm (IQR 2.0-3.7) and median RENAL score was 7 (IQR 6-9). Clear cell carcinoma was present in 67.8% of cases, and two cases (1.7%) had positive surgical margins. Glomerular filtration rate preservation was 87.8% (IQR 74.9-98.1), which translates to 19.1% chronic kidney disease upstaging. The median follow-up was 61.9 mo (IQR 50.9-71.4) and the 5-yr OS, CFS, and CSS were 91.1%, 97.8%, and 97.8%, respectively. On univariable logistic regression, ACCI was the only factor associated with a higher risk of overall mortality (OR 1.67, p = 0.006). The retrospective design, the high surgical volume at our institution, and the potential selection bias with careful patient selection early in the RPN experience may limit the generalizability of our findings. Conclusions This is the first study confirming excellent long-term oncologic outcomes after RPN in a selected cohort of patients. Patient summary Robotic partial nephrectomy is a relatively recently developed treatment for renal cell carcinoma. This study confirms its safety and reports excellent long-term cancer control.
KW - Long-term outcome
KW - Minimally invasive surgery
KW - Oncology
KW - Renal cell carcinoma
KW - Robotic partial nephrectomy
UR - http://www.scopus.com/inward/record.url?scp=84951132063&partnerID=8YFLogxK
U2 - 10.1016/j.eururo.2015.12.004
DO - 10.1016/j.eururo.2015.12.004
M3 - Article
C2 - 26719014
AN - SCOPUS:84951132063
SN - 0302-2838
VL - 69
SP - 1149
EP - 1154
JO - European Urology
JF - European Urology
IS - 6
ER -
