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• W2811235248 abstract "No AccessJournal of UrologyAdult Urology1 Jan 2019cT1a Renal Masses Less Than 2 versus 2 cm or Greater Managed by Robotic Partial Nephrectomy: A Propensity Score Matched Comparison of Perioperative Outcomes Riccardo Bertolo, Juan Garisto, Julien Dagenais, Daniel Sagalovich, Jose Agudelo, Robert Stein, Khaled Fareed, Tianming Gao, Amr Fergany, and Jihad Kaouk Riccardo BertoloRiccardo Bertolo Glickman Urological and Kidney Institute and Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio More articles by this author , Juan GaristoJuan Garisto Glickman Urological and Kidney Institute and Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio More articles by this author , Julien DagenaisJulien Dagenais Glickman Urological and Kidney Institute and Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio More articles by this author , Daniel SagalovichDaniel Sagalovich Glickman Urological and Kidney Institute and Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio More articles by this author , Jose AgudeloJose Agudelo Glickman Urological and Kidney Institute and Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio More articles by this author , Robert SteinRobert Stein Glickman Urological and Kidney Institute and Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio More articles by this author , Khaled FareedKhaled Fareed Glickman Urological and Kidney Institute and Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio More articles by this author , Tianming GaoTianming Gao Glickman Urological and Kidney Institute and Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio More articles by this author , Amr FerganyAmr Fergany Glickman Urological and Kidney Institute and Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio More articles by this author , and Jihad KaoukJihad Kaouk *Correspondence: Glickman Urology and Kidney Institute, Cleveland Clinic, 9500 Euclid Ave., Q10, Cleveland, Ohio 44195 (telephone: 216-444-2976; e-mail: E-mail Address: [email protected]). Glickman Urological and Kidney Institute and Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio Financial interest and/or other relationship with Intuitive Surgical and Endocare. More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2018.06.066AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract Purpose: We performed a single center evaluation to compare perioperative, pathological and functional outcomes of robotic partial nephrectomy of T1a renal masses less than vs greater than 2 cm. Materials and Methods: Propensity score 1:1 matching of queried patients was performed using the institutional robotic partial nephrectomy database from January 2007 to January 2017. Matching was done by patient age, gender, race, body mass index, the Charlson comorbidity index, smoking status, diabetes, hypertension, hyperlipidemia, ASA® (American Society of Anesthesiologists®) score, estimated glomerular filtration rate, chronic kidney disease stage and R.E.N.A.L. (radius, exophytic/endophytic properties, nearness of tumor to collecting system or sinus, anterior/posterior, location relative to polar line and abutting main renal artery or vein) score. We analyzed the records of 524 patients, including 262 with a renal mass less than 2 cm vs 262 with a renal mass 2 cm or greater. Perioperative, pathological and functional outcomes were evaluated. Results: Smaller renal masses (less than 2 cm) were associated with significantly lower operative time, blood loss, ischemia time (mean ± SD 14.3 ± 9.58 vs 21.5 ± 9.51 minutes, p <0.001) and intraoperative transfusions (0% vs 2.7%, p = 0.015). Moreover, we found superior early renal functional outcomes as assessed by the estimated glomerular filtration rate on postoperative day 1 (mean 83.1 ± 21.3 vs 76.6 ± 22.0 mg/ml/1.73 m2, p = 0.001), greater parenchymal preservation (mean 89.9% ± 9.45% vs 83.6% ± 8.20%, p <0.001) and a trend toward a lower rate of postoperative complications (13.5% vs 19.5%, p = 0.080). A higher incidence of malignancy was found in larger tumors (85.9% vs 74.8%, p = 0.002) but no difference was recorded in positive surgical margins. Conclusions: Robotic partial nephrectomy tends to be a low morbidity treatment modality for renal masses less than 2 cm. Although active surveillance is a common option for such tumors, robotic partial nephrectomy remains an alternative in select patients. References 1. : Cancer statistics, 2017. CA Cancer J Clin 67: 7. Google Scholar 2. : Clinical practice. Small renal mass. N Engl J Med 2010; 362: 624. 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Google Scholar 21. : Laparoscopic cryoablation for renal cell carcinoma: 100-month oncologic outcomes. J Urol 2015; 194: 892. Link, Google Scholar 22. : Laparoscopic cryoablation for clinical stage T1 renal masses: long-term oncologic outcomes at the Medical College of Wisconsin. Urology 2014; 84: 613. Google Scholar 23. : Laparoscopic renal cryoablation: 8-year, single surgeon outcomes. J Urol 2010; 183: 889. Link, Google Scholar 24. : Laparoscopic cryoablation of renal masses: single-center long-term experience. Urology 2012; 80: 307. Google Scholar 25. : Perioperative, oncologic, and functional outcomes of laparoscopic renal cryoablation and open partial nephrectomy: a matched pair analysis. J Endourol 2011; 25: 991. Google Scholar 26. : Renal cryoablation versus robot-assisted partial nephrectomy: Washington University long-term experience. J Endourol 2013; 27: 1477. Google Scholar 27. : Robotic partial nephrectomy versus laparoscopic cryoablation for the small renal mass. Eur Urol 2012; 61: 899. Google Scholar 28. : Laparoscopic vs percutaneous cryotherapy for renal tumors: a systematic review and meta-analysis. J Endourol 2018; 32: 177. Google Scholar 29. : Warm ischemia less than 30 minutes is not necessarily safe during partial nephrectomy: every minute matters. Urol Oncol 2011; 29: 826. Google Scholar 30. : Transperitoneal robot-assisted partial nephrectomy with a minimum follow-up of 5 years: oncological and functional outcomes from a single institution. Eur Urol Oncol 2018; doi: 10.1016/j.euo.2018.06.012. Crossref, Google Scholar No direct or indirect commercial incentive associated with publishing this article. The corresponding author certifies that, when applicable, a statement(s) has been included in the manuscript documenting institutional review board, ethics committee or ethical review board study approval; principles of Helsinki Declaration were followed in lieu of formal ethics committee approval; institutional animal care and use committee approval; all human subjects provided written informed consent with guarantees of confidentiality; IRB approved protocol number; animal approved project number. © 2019 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetailsCited BySmith J (2018) This Month in Adult UrologyJournal of Urology, VOL. 201, NO. 1, (1-2), Online publication date: 1-Jan-2019. Volume 201Issue 1January 2019Page: 56-61Supplementary Materials Advertisement Copyright & Permissions© 2019 by American Urological Association Education and Research, Inc.Keywordsroboticsnephrectomymorbiditykidneyrenal cellcarcinomaMetricsAuthor Information Riccardo Bertolo Glickman Urological and Kidney Institute and Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio More articles by this author Juan Garisto Glickman Urological and Kidney Institute and Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio More articles by this author Julien Dagenais Glickman Urological and Kidney Institute and Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio More articles by this author Daniel Sagalovich Glickman Urological and Kidney Institute and Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio More articles by this author Jose Agudelo Glickman Urological and Kidney Institute and Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio More articles by this author Robert Stein Glickman Urological and Kidney Institute and Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio More articles by this author Khaled Fareed Glickman Urological and Kidney Institute and Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio More articles by this author Tianming Gao Glickman Urological and Kidney Institute and Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio More articles by this author Amr Fergany Glickman Urological and Kidney Institute and Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio More articles by this author Jihad Kaouk Glickman Urological and Kidney Institute and Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio *Correspondence: Glickman Urology and Kidney Institute, Cleveland Clinic, 9500 Euclid Ave., Q10, Cleveland, Ohio 44195 (telephone: 216-444-2976; e-mail: E-mail Address: [email protected]). Financial interest and/or other relationship with Intuitive Surgical and Endocare. More articles by this author Expand All No direct or indirect commercial incentive associated with publishing this article. The corresponding author certifies that, when applicable, a statement(s) has been included in the manuscript documenting institutional review board, ethics committee or ethical review board study approval; principles of Helsinki Declaration were followed in lieu of formal ethics committee approval; institutional animal care and use committee approval; all human subjects provided written informed consent with guarantees of confidentiality; IRB approved protocol number; animal approved project number. Advertisement Loading ..." @default.
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