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, Woong Kyu Han, Young Deuk Choi, Byung Ha Chung, Koon Ho Rha

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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

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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 Han, {Woong Kyu} and Choi, {Young Deuk} and Chung, {Byung Ha} and Rha, {Koon Ho}",
year = "2018",
month = "10",
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, Woong Kyu; Choi, Young Deuk; Chung, Byung Ha; Rha, Koon Ho.

In: BJU International, Vol. 122, No. 4, 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, Woong Kyu

AU - Choi, Young Deuk

AU - Chung, Byung Ha

AU - Rha, Koon Ho

PY - 2018/10

Y1 - 2018/10

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 -