ABSTRACT
Background@#To compare open partial nephrectomy (OPN) and robot-assisted partial nephrectomy (RAPN) in the management of renal tumors larger than 4 cm. @*Methods@#Clinical records of 220 patients who underwent OPN or RAPN for a single renal tumor ≥ 4.0 cm with a normal contralateral kidney were reviewed. After determining the propensity score, surgical parameters, functional outcomes, and oncological outcomes were compared between OPN (n = 67) and RAPN (n = 67) groups of patients. @*Results@#The RAPN group had longer operation time (149.0 min vs. 173.3 min, P = 0.030) and longer ischemic time (20.3 min vs. 29.4 min, P = 0.001), but shorter hospital stay (8.2 days vs 6.0 days, P = 0.001) than the OPN group. Estimated blood loss (P = 0.053), pain visual analog score at 1 day postoperatively (P = 0.194), and complications of grade III or higher (P = 0.403) were similar between OPN and RAPN groups. There was no radical conversion or positive surgical margin in either group. Mean change in 6-month estimated glomerular filtration rate was significantly better in the RAPN group (−8.2 vs. −3.1, P = 0.027). There was no statistical difference in recurrence-free survival (P = 0.970) or cancer-specific survival (P = 0.345) between the two groups. @*Conclusion@#RAPN is a safe and feasible surgical modality comparable to OPN for managing renal tumors larger than 4 cm in terms of surgical, functional, and oncological outcomes.
ABSTRACT
Background@#To compare open partial nephrectomy (OPN) and robot-assisted partial nephrectomy (RAPN) in the management of renal tumors larger than 4 cm. @*Methods@#Clinical records of 220 patients who underwent OPN or RAPN for a single renal tumor ≥ 4.0 cm with a normal contralateral kidney were reviewed. After determining the propensity score, surgical parameters, functional outcomes, and oncological outcomes were compared between OPN (n = 67) and RAPN (n = 67) groups of patients. @*Results@#The RAPN group had longer operation time (149.0 min vs. 173.3 min, P = 0.030) and longer ischemic time (20.3 min vs. 29.4 min, P = 0.001), but shorter hospital stay (8.2 days vs 6.0 days, P = 0.001) than the OPN group. Estimated blood loss (P = 0.053), pain visual analog score at 1 day postoperatively (P = 0.194), and complications of grade III or higher (P = 0.403) were similar between OPN and RAPN groups. There was no radical conversion or positive surgical margin in either group. Mean change in 6-month estimated glomerular filtration rate was significantly better in the RAPN group (−8.2 vs. −3.1, P = 0.027). There was no statistical difference in recurrence-free survival (P = 0.970) or cancer-specific survival (P = 0.345) between the two groups. @*Conclusion@#RAPN is a safe and feasible surgical modality comparable to OPN for managing renal tumors larger than 4 cm in terms of surgical, functional, and oncological outcomes.
ABSTRACT
PURPOSE: The aim of this study is evaluating the accuracy of preoperative magnetic resonance imaging (MRI) in patients who underwent pelvic lymph node dissection (PLND). MATERIALS AND METHODS: The medical records of 1,528 patients who underwent radical prostatectomy and PLND from 2003 to 2017 in Seoul National University Bundang Hospital were retrospectively reviewed. We evaluated the various clinicopathologic variables including preoperative MRI findings and pathologic lymph node (LN) metastasis. The prediction model for pathologic LN metastasis was assessed using univariate and multivariable logistic regression analyses and areas under receiver operating characteristic (ROC) curves. RESULTS: The mean age of our cohort was 66.4±6.7 years. Positive LN finding of preoperative MRI finding was observed in 9.4% (145 of 1,528) of patients. 5.3% (81 of 1,528) of patients had confirmed final pathologic LN metastases. Sensitivity and specificity of preoperative MRI were 30.8% and 91.7%, respectively. Multivariable analysis showed that preoperative MRI findings, clinical stage and biopsy Gleason score were independent significant predictors for pathologic LN metastasis (p < 0.001, p=0.002, and p < 0.001, respectively). Prediction model using preoperative MRI findings and National Comprehensive Control Network risk stratification showed fair accuracy using ROC analysis. CONCLUSIONS: Preoperative MRI findings for pathologic LN metastasis showed limited prediction value. A large-scale, multicenter, prospective study is needed to fully evaluate the clinical significance of preoperative MRI.