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Safety and Efficacy of Robot-Assisted Partial Nephrectomy: A Large Single Institution Experience
Kevin J. Tsai, Jay Simhan, Marc C. Smaldone, Alexander Kutikov, David Y.T. Chen, Robert G. Uzzo, Rosalia Viterbo
Fox Chase Cancer Center, Philadelphia, PA
Introduction: Although it is an acceptable treatment option for small renal masses, the role of robot-assisted partial nephrectomy (RPN) in complex tumors is not well understood.
Materials & Methods: We provide a large institutional study of demographics, tumor anatomic complexity, perioperative outcomes, pathology, complications, and follow-up data for RPN cases from 2007-2010.
Results: 174 patients (mean age 56.7+12.7yrs, 63.7% male, mean tumor size 2.95+1.63cm) with mean follow-up 17.5+9.8mos underwent RPN during the study period. Lesion complexity stratified by Nephrometry score was low, moderate, and high in 83 (47.7%), 81 (46.6%), and 10 (5.7%) patients. 95 (54.6%) patients had predominantly endophytic or entirely intraparenchymal tumors while 100 (57.5%) had tumors <7mm of the renal sinus or collecting system. Mean warm ischemia time was 27.8+11.5min, and 12.0% (n=21 pts) were performed without hilar clamping. Mean operative time was 203.2+69.0min, and mean EBL was 118.6+129.6mL. Transfusions were required in 9 (5.2%) patients. Final pathology was pT1a (85.3%), pT1b (9.6%), pT2 (0.6%), pT3 (4.5%). Histology was malignant in 78.7% of tumors: 68.6% clear cell, 24.8% papillary, 5.9% chromophobe, and 0.7% were undefined. There were 4 (2.3%) positive margins on final pathology. Major (Clavien III-IV) and minor (Clavien I-II) complication rates were 6.8% and 22.7%. Mean change in postoperative GFR was 4.21 mL/min /1.73m2. Local recurrence was noted in 2 patients (1.1%) and progression in 1 patient (0.6%).
Conclusions: Our RPN experience demonstrates minimal morbidity and acceptable oncologic Results with excellent functional preservation in intermediate and high complexity renal tumors.
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