Abstract
Thank you for your insight and we agree that selection bias is one of the inherent limitations in the context of retrospective studies such as the present. Some of the substantial factors that define the best treatment option in kidney cancer are the preoperative imaging and pathologic features. NSQIP data set is lacking for such features that reflect anatomic complexity and technicality of cases. It is well known that open partial nephrectomy (OPN) still deems a prior option in selective cases of kidney cancer even when minimally invasive treatment is also accessible. Objective tools such as nephrometry score along with patient's performance status help the surgeon to some extent in decision making.
In our study, despite that we observed more favorable preoperative indices in the minimally invasive partial nephrectomy (MIPN) group compared with OPN, the majority of patients in both groups were American Society of Anesthesiologists class III. The other observation was the MIPN being performed in a considerable higher rate (66%) than OPN (34%) in the obese population. This may point out that urologists started being more comfortable performing MIPN even in high complexity cases where most of the urologists would perform OPN rather than MIPN. In addition, some literature provided evidence of similar outcomes in terms of functional preservation and perioperative complications among patients with chronic kidney disease. 1
Certainly randomized controlled studies are warranted for more comprehensive generalizable results and to demonstrate high-quality evidence. 2 Despite the present limitations, our study provides a comprehensive report of the perioperative morbidity of MIPN compared with OPN in obese patients in a contemporary national cohort, as well as characterization of the timing of postoperative complications, hospital readmission, and reoperation.