A comparison of outcomes regarding robotic versus open partial nephrectomy.

Abstract

441 Background: The latest SEER Cancer Statistics estimated that 60,920 new cases of kidney cancer were diagnosed in 2011 in the United States. The standard of care for small renal masses has transitioned from radical to partial nephrectomy with strong data to support excellent oncologic outcomes, long-term preservation of renal function, and better overall survival. The literature shows that laparoscopic approaches are favorable when compared to open techniques, but outcomes in robotic surgery are still gaining data. The objective of this study is to perform a review of outcomes comparing open versus robotic partial nephrectomy. Our hypothesis is that surgical outcomes and length of stay will favor robotic surgery. Methods: We performed a retrospective review of partial nephrectomies from 2009 to 2012 for solitary masses suspected as carcinoma at the Kansas University Medical Center. Estimated blood loss, age, length of stay, intraoperative transfusion, and margin status were recorded. When available, nephrometry scores were calculated based on preoperative imaging. Results: A total of 78 open partial nephrectomies and 63 robotic partial nephrectomies were analyzed. In the open cohort, the surgical blood loss was higher compared to the robotic cohort (328ml vs. 222ml, p=0.03). Nephrometry scores and mean mass size were higher in the open cohort (7.3 vs. 5.9, p<0.01 and 3.2cm vs. 2.7cm, p=0.01, respectively). The mean length of stay was 2.8 days for the robotic cohort and 4.3 days for the open cohort. No significant difference was noted in age or BMI. Of note, there were five intraoperative blood transfusions in the open group and none in the robotic group. Four margins were positive in the robotic cohort and one in the open cohort. Nephrometry score and mass size did not correlate with blood loss. Conclusions: For partial nephrectomy blood loss is significantly lower with robotic techniques as compared to open surgery. This relationship is not affected by mass size or nephrometry score. Positive margins rate is higher in robotic surgery, while blood transfusion rate is lower in robotic surgery. Length of stay is decreased with robotic surgery. Robotic partial nephrectomy seems to afford the advantage of decreased blood loss and decreased length of stay.