Renal recurrence after zero ischemia partial nephrectomy

==inizio abstract==

OBJECTIVE: to evaluate renal recurrence (RR) and incidence of positive surgical margins (PSMs) in patients who underwent zero ischemia partial nephrectomy (ZIPN) regardless the approach performed (open, laparoscopic and robot-assisted).

Methods: we retrospectively analyzed data of 534 consecutive patients with diagnosis of renal tumors and treated with open, laparoscopic and robot-assisted ZIPN between 2001 and 2011. Survival curves were extimated with Kaplan Meier method and compared with Log Rank test.
RESULTS: At a median follow-up of 28 months (range 1-120); renal recurrence was observed in 31 patients (5,8%) with a median time to renal recurrence of 16 months (range 2-80). PSMs were observed in in 23 patients (3,8%). Five years renal recurrence free survival (RRFS)was 89%. After stratifying for:
– Fuhrman grade 5yrs RRFS was 93% for G1-G2 vs 74% for G3-G4 [p=0,0001]) ;
– Histological subtype 5 yrs RRFS was 100% for chromophobe renal tumors, 100% for papillary type 1, 86% for papillary type 2 and 87% for ccRCC [p=0,008]);
– Tumor size 5yrs RRFS for pT1a and pT1b was 89% and 90% respectively [p=0,2]) ;
– Positive and negative surgical margins 5yrs RRFS was 89% in both groups [p=0,75]).
Disease free surviva (DFS)for G1-2 and G3-4 patients was 87% and 60%, respectively. Adjusted for histological subtype DFS was 97% for chromophobe renal tumors , 89% for papillary type 1, 53% for papillary type 2 and 79% for ccRCC. pT and PSMs didn’t show any impact on renal recurrence.
CONCLUSIONS: Avoiding hilar clamping doesn’t undermine oncologic outcomes in terms of 5 years renal recurrence .

==fine abstract==