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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

Title
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
Authors
Chang, Ki DonRaheem, Ali AbdelKim, Kwang HyunOh, Cheol KyuPark, Sung YulKim, Young SikHam, Won SikHan, Woong KyuChoi, Young DeukChung, Byung HaRha, Koon Ho
Ewha Authors
김광현
SCOPUS Author ID
김광현scopus
Issue Date
2018
Journal Title
BJU INTERNATIONAL
ISSN
1464-4096JCR Link

1464-410XJCR Link
Citation
BJU INTERNATIONAL vol. 122, no. 4, pp. 618 - 626
Keywords
partial nephrectomyrobot-assistedopenlaparoscopiclong-term outcomes
Publisher
WILEY
Indexed
SCIE; SCOPUS WOS scopus
Document Type
Article
Abstract
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.
DOI
10.1111/bju.14250
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의과대학 > 의학과 > Journal papers
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