Retroperitoneal Robot-Assisted Versus Open Partial Nephrectomy for cT1 Renal Tumors: A Matched-Pair Comparison of Perioperative and Early Oncological Outcomes

Abstract

Background: The objective of this study was to compare perioperative and early oncological outcomes of a matched cohort of patients who underwent retroperitoneal robot-assisted partial nephrectomy (RP-RAPN) and open partial nephrectomy (OPN) for clinically localized renal tumors.

Patients and methods: We performed a retrospective analysis of patients who underwent RP-RAPN and OPN treated at 2 referral centers from January 2011 to December 2015. We focused on the following postoperative outcomes: warm ischemia time (WIT), operative time, blood loss, intra- and postoperative complications, estimated glomerular filtration rate (eGFR), hospital stay, and positive surgical margins. Because of inherent differences between patients in terms of baseline and disease characteristics, we relied on a propensity score-matched analysis to adjust for these differences.

Results: Globally, 104 patients were retrospectively evaluated and compared (52 matched individuals). RP-RAPN and OPN groups were comparable in terms of median age, body mass index, Charlson Comorbidity Index, clinical tumor size, preoperative aspects and dimensions used for anatomic classification and radius, exophyic/endophytic, nearness, anterior/posterior location score. Overall median operative time and WIT were significantly higher in the RP-RAPN group compared with the OPN group (P < .001). Intraoperative (3.8% vs. 0%) and postoperative (21.2% vs. 7.7%) complication rates were higher in the OPN group (P < .001). No statistically significant differences in postoperative eGFR were found. Median length of stay was significantly shorter in the RP-RAPN group (3 vs. 5 days; P < .001). The incidence of positive surgical margins was comparable (3.8%). Trifecta was reached in 82.6% after RP-RAPN and 71.1% after OPN (P = .002).

Conclusion: Retroperitoneal robot-assisted partial nephrectomy offered promising perioperative, early oncological, and functional outcomes, reinforcing the role of robotics as an alternative to open approach for partial nephrectomy.

Keywords: Complications; Functional outcomes; Open approach; Positive surgical margins; Retroperitoneal robotic nephron-sparing surgery.