Robot-assisted laparoscopic partial nephrectomy for tumors greater than 4 cm and high nephrometry score: feasibility, renal functional, and oncological outcomes with minimum 1 year follow-up Journal Article

Local Library Link: Find It @ Loyola

Authors: Gupta, G. N.; Boris, R.; Chung, P.; Linehan, W. M.; Pinto, P. A.; Bratslavsky, G.
Article Title: Robot-assisted laparoscopic partial nephrectomy for tumors greater than 4 cm and high nephrometry score: feasibility, renal functional, and oncological outcomes with minimum 1 year follow-up
Abstract: OBJECTIVES: Minimally invasive robotic assistance is being increasingly utilized to treat larger complex renal masses. We report on the technical feasibility and renal functional and oncologic outcomes with minimum 1 year follow-up of robot-assisted laparoscopic partial nephrectomy (RALPN) for tumors greater than 4 cm. MATERIALS AND METHODS: The urologic oncology database was queried to identify patients treated with RALPN for tumors greater than 4 cm and a minimum follow-up of 12 months. We identified 19 RALPN on 17 patients treated between June 2007 and July 2009. Two patients underwent staged bilateral RALPN. Demographic, operative, and pathologic data were collected. Renal function was assessed by serum creatinine levels, estimated glomerular filtration rate, and nuclear renal scans assessed at baseline, 3, and 12 months postoperatively. All tumors were assigned R.E.N.A.L. nephrometry scores (http://www.nephrometry.com). RESULTS: The median nephrometry score for the largest tumor from each kidney was 9 (range 6-11) while the median size was 5 cm (range 4.1-15). Three of 19 cases (16%) required intraoperative conversion to open partial nephrectomy. No renal units were lost. There were no statistically significant differences between preoperative and postoperative creatinine and eGFR. A statistically significant decline of ipsilateral renal scan function (49% vs. 46.5%, P = 0.006) was observed at 3 months and at 12 mo postoperatively (49% vs. 45.5%, P = 0.014). None of the patients had evidence of recurrence or metastatic disease at a median follow-up of 22 months (range 12-36). CONCLUSIONS: RALPN is feasible for renal tumors greater than 4 cm with moderate or high nephrometry scores. Although there was a modest decline in renal function of the operated unit, RALPN may afford the ability resect challenging tumors requiring complex renal reconstruction. The renal functional and oncologic outcomes are promising at a median follow-up of 22 months, but longer follow-up is required.
Journal Title: Urologic oncology
Volume: 31
Issue: 1
ISSN: 1873-2496; 1078-1439
Publisher: Elsevier Inc  
Journal Place: United States
Date Published: 2013
Start Page: 51
End Page: 56
Language: eng
DOI/URL:

10.1016/j.urolonc.2010.10.008

10.1016/j.urolonc.2010.10.008
Notes: CI: Published by Elsevier Inc.; GR: Z01 BC011023-01/BC/NCI NIH HHS/United States; GR: Z01 BC011028-01/BC/NCI NIH HHS/United States; GR: Z01 BC011038-01/BC/NCI NIH HHS/United States; GR: Z01 BC011043-01/BC/NCI NIH HHS/United States; JID: 9805460; NIHMS271526; OID: NLM: NIHMS271526 [Available on 01/01/14]; OID: NLM: PMC3123423 [Available on 01/01/14]; PMCR: 2014/01/01 00:00; 2010/09/29 [received]; 2010/10/29 [revised]; 2010/10/29 [accepted]; 2011/02/02 [aheadofprint]; ppublish