Open Partial Nephrectomy: One Night Length of Stay Is Safe and Cost Effective

Objective: To review our open partial nephrectomy (OPN) experience and compare to known robotic partial nephrectomy (RPN) data to determine whether length of stay (LOS) and morbidity are significant drivers in the surgical approach employed for partial nephrectomy. Methods: We reviewed our OPN experience during the last 3 years examining age, tumor size, LOS, pathology, blood loss, complications, recurences, and deaths. Results: Seventy-five patients underwent OPN during this period. Mean age was 59 years, tumor size 2.8 cm, percent malignant 75%, estimated blood loss 350 cc. With a median follow-up of 18 months, there was one urinoma managed by drain-age, one pseudo aneurysm that required embolization and one pulmonary embolism that required anticoagulation. There were no readmissions, no tumor recurences, and no deaths. Our major complication rate was 4% as compared to other trials that re-ported major complication rates between 1% - 9% for RPN and between 3% - 24% for OPN. In the first half of the experience (n = 37), median LOS was 57 hours. Using a pathway encouraging early ambulation and smaller incisions in the second half of the experience (n = 38), median LOS was 35 hours. This is much shorter than reported RPN LOS of 62 - 67 hours and OPN LOS of 108 - 142 hours. Conclusion: OPN can be performed safely and effectively with one night hospital stay. This provides a more cost-effective approach to partial nephrectomy with similar or better complication rates and calls into question the main value drivers of RPN.

Long-term oncologic outcomes of laparoscopic versus open partial nephrectomy

Background Most of the literatures on laparoscopic partial nephrectomy （LPN） versus open partial nephrectomy （OPN） focus on technical details and early or mid-term oncologic outcomes, reflecting that the approach is safe and provides mid- term benefits compared with traditional open surgery. However, the difference of long-term oncologic outcome between LPN and OPN remains unclear. The aim of this meta-analysis was to evaluate the long-term oncologic outcome of LPN in the treatment of localized renal tumors compared with that of OPN. Methods A systematic search of electronic databases including Medline, Embase, and Cochrane library was conducted. Comparative studies reporting on long-term oncologic outcome of LPN versus OPN were regarded eligible. The odds ratio （OR） and its corresponding 95% confidence intervals （CO were calculated for the oncologic outcomes. The methodologic quality of the included studies was evaluated using the strict criteria of the Newcastle-Ottawa scale. Results Six comparative studies （1495 participants including 555 LPN and 940 OPN） were included in the present study. There was no significant difference between LPN and OPN in 5-year overall survival （OS） rates （OR=1.83, 95% Cl （0.80, 4.19））, 5-year cancer specific survival （CSS） rates （OR=1.09, 95% CI （0.62, 1.92））, and 5-year recurrence free survival （RFS） rates （OR=0.68, 95% CI （0.37, 1.26））. Conclusion The results of this meta-analysis revealed that there was no significant difference in long-term oncologic outcome between LPN and OPN for treatment of localized renal tumors.