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Open Access Research article

Prospective multi-center study of oncologic outcomes of robot-assisted partial nephrectomy for pT1 renal cell carcinoma

Rachel L Kyllo1, Youssef S Tanagho1, Jihad H Kaouk2, Michael D Stifelman3, Craig G Rogers4, Shahab P Hillyer2, Shyam S Sukumar4, Kenneth G Nepple1 and Sam B Bhayani15*

Author Affiliations

1 Division of Urology, Washington University School of Medicine, St Louis, MO, USA

2 Glickman Urological Institute, Cleveland Clinic, Cleveland, OH, USA

3 Department of Urology, NYU Langone School of Medicine, New York, NY, USA

4 Department of Urology, Henry Ford Hospital, Detroit, MI, USA

5 Division of Urology, Washington University School of Medicine, 660 S. Euclid Avenue, St. Louis, MO, 63110, USA

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BMC Urology 2012, 12:11  doi:10.1186/1471-2490-12-11

Published: 30 April 2012

Abstract

Background

Partial nephrectomy has been increasingly recommended over radical nephrectomy for the management of small renal masses based on improved renal functional outcomes without sacrifice of oncologic effectiveness. Robot-assisted partial nephrectomy (RAPN) has been introduced in an effort to offer another minimally invasive option for nephron-sparing surgery. However, reports of RAPN have been limited to short-term perioperative outcomes. The goal of this study is to report and evaluate the initial oncologic outcomes of RAPN. Utilizing prospectively obtained data on RAPN performed by four surgeons at four separate tertiary care centers, we selected patients with unilateral, localized, non-familial, pathologically-confirmed pT1 renal cell carcinoma and a minimum post-operative follow-up of 12 months.

Methods

Utilizing prospectively obtained data on RAPN performed by four surgeons at four separate tertiary care centers, we selected patients with unilateral, localized, non-familial, pathologically-confirmed pT1 renal cell carcinoma and a minimum post-operative follow-up of 12 months. Survival analysis (disease-free, cancer-specific, and overall survival) was performed, and Kaplan-Meier curves were generated.

Results

RAPN was performed in 124 patients with a median tumor size of 3.0 cm (IQR 2.2-4.2 cm). Median follow-up was 29 months (range 12-46 months). Positive parenchymal surgical margins occurred in two patients (1.6 %), both of whom were recurrence-free at 30 and 34 months after surgery. The three-year Kaplan-Meier estimated disease-free survival was 94.9 %, cancer-specific survival was 99.1 %, and overall survival was 97.3 %.

Conclusions

In our cohort of patients with small renal carcinomas who were followed for a median of 29 months, recurrence and survival outcomes were similar to those reported for open and laparoscopic partial nephrectomy. Further long-term outcomes will be needed to definitively claim that RAPN is oncologically equivalent to other surgical approaches.

Keywords:
Renal cell carcinoma; Partial nephrectomy; Robotic partial nephrectomy; Oncologic outcomes; Nephron-sparing surgery