Functional and oncological outcomes of open, laparoscopic and robot-assisted partial nephrectomy: a multicentre comparative matched-pair analyses with a median of 5 years' follow-up.
OBJECTIVES
To compare outcomes at a 5-year median follow-up among different partial nephrectomy (PN) approaches: robot-assisted (RAPN), laparoscopic (LPN) and open partial nephrectomy (OPN).


PATIENTS AND METHODS
We retrospectively analysed 1 308 patients who underwent PN (RAPN, n = 380; LPN, n = 206; OPN, n = 722) between 2006 and 2012 at one of four academic centres. We performed 1:1:1 propensity-score-matching adjustment based on confounding variables among groups, and 366 patients (122 in each group) were included in the final analysis. Survival rates were analysed using the Kaplan-Meier method.


RESULTS
The median follow-up periods were 60, 59.8 and 64.1 months for RAPN, LPN and OPN, respectively. In the matched groups, RAPN resulted in significantly lower mean estimated blood loss compared with LPN (P = 0.025) and OPN (P = 0.040), while LPN was associated with a longer mean operating time compared with RAPN (P = 0.001) and OPN (P = 0.001). The hospital stay was shorter in the RAPN group (P = 0.008). Regarding the oncological outcomes, there were no significant differences among the three groups in local recurrence rate (P = 0.882), distant metastasis rate (P = 0.816) or deaths from cancer (P = 0.779). At latest follow-up, the incidence of chronic kidney disease (CKD) upstaging was significantly lower in RAPN compared with LPN (20.55% vs 32%; P = 0.035) and OPN (20.5% vs 33.6%; P = 0.038). The 5-year CKD free-survival rate was significantly higher (78.4%) in the RAPN group compared with 58.8% and 65.8% in the LPN and OPN groups, respectively (log-rank P = 0.031).


CONCLUSIONS
In the present study, RAPN, LPN and OPN had similar local recurrence, distant metastasis and cancer-related death rates at a 5-year median follow-up. In terms of functional outcomes, RAPN was associated with a lower incidence of CKD upstaging compared with OPN and LPN.
['Chang|Ki Don|KD|', 'Abdel Raheem|Ali|A|0000-0002-9294-2665', 'Kim|Kwang Hyun|KH|', 'Oh|Cheol Kyu|CK|', 'Park|Sung Yul|SY|', 'Kim|Young Sik|YS|', 'Ham|Won Sik|WS|0000-0003-2246-8838', 'Han|Woong Kyu|WK|', 'Choi|Young Deuk|YD|0000-0002-8545-5797', 'Chung|Byung Ha|BH|0000-0001-9817-3660', 'Rha|Koon Ho|KH|0000-0001-8588-7584']
D000328:Adult D000368:Aged D005260:Female D005500:Follow-Up Studies D006801:Humans D007680:Kidney Neoplasms D010535:Laparoscopy D008297:Male D016555:Matched-Pair Analysis D008875:Middle Aged D009392:Nephrectomy D011183:Postoperative Complications D012189:Retrospective Studies D065287:Robotic Surgical Procedures D016896:Treatment Outcome
open laparoscopic robot-assisted partial nephrectomy long-term outcomes