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

Ki Don Chang, Ali Abdel Raheem, Kwang Hyun Kim, Cheol Kyu Oh, Sung Yul Park, Young Sik Kim, Won Sik Ham, WoongKyu Han, Youngdeuk Choi, Byungha Chung, KoonHo Rha

Research output: Contribution to journalArticle

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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.

Original languageEnglish
Pages (from-to)618-626
Number of pages9
JournalBJU International
Volume122
Issue number4
DOIs
Publication statusPublished - 2018 Oct 1

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Matched-Pair Analysis
Nephrectomy
Chronic Renal Insufficiency
Survival Rate
Neoplasm Metastasis
Recurrence
Propensity Score
Confounding Factors (Epidemiology)
Incidence
Disease-Free Survival
Length of Stay
Neoplasms
Research Design

All Science Journal Classification (ASJC) codes

  • Urology

Cite this

@article{3da0ed26ab7d49608eb507ae1602c2b7,
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",
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.",
author = "Chang, {Ki Don} and {Abdel Raheem}, Ali and Kim, {Kwang Hyun} and Oh, {Cheol Kyu} and Park, {Sung Yul} and Kim, {Young Sik} and Ham, {Won Sik} and WoongKyu Han and Youngdeuk Choi and Byungha Chung and KoonHo Rha",
year = "2018",
month = "10",
day = "1",
doi = "10.1111/bju.14250",
language = "English",
volume = "122",
pages = "618--626",
journal = "BJU International",
issn = "1464-4096",
publisher = "Wiley-Blackwell",
number = "4",

}

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. / Chang, Ki Don; Abdel Raheem, Ali; Kim, Kwang Hyun; Oh, Cheol Kyu; Park, Sung Yul; Kim, Young Sik; Ham, Won Sik; Han, WoongKyu; Choi, Youngdeuk; Chung, Byungha; Rha, KoonHo.

In: BJU International, Vol. 122, No. 4, 01.10.2018, p. 618-626.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Functional and oncological outcomes of open, laparoscopic and robot-assisted partial nephrectomy

T2 - a multicentre comparative matched-pair analyses with a median of 5 years’ follow-up

AU - Chang, Ki Don

AU - Abdel Raheem, Ali

AU - Kim, Kwang Hyun

AU - Oh, Cheol Kyu

AU - Park, Sung Yul

AU - Kim, Young Sik

AU - Ham, Won Sik

AU - Han, WoongKyu

AU - Choi, Youngdeuk

AU - Chung, Byungha

AU - Rha, KoonHo

PY - 2018/10/1

Y1 - 2018/10/1

N2 - 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.

AB - 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.

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U2 - 10.1111/bju.14250

DO - 10.1111/bju.14250

M3 - Article

C2 - 29645344

AN - SCOPUS:85053920912

VL - 122

SP - 618

EP - 626

JO - BJU International

JF - BJU International

SN - 1464-4096

IS - 4

ER -