Abstract
Aim: Partial nephrectomy is the standard treatment for small renal tumors; however, it remains unclear which surgical approach from among robot-assisted partial nephrectomy (RAPN) and open partial nephrectomy (OPN) is superior. This study aimed to compare perioperative outcomes of RAPN and OPN performed at a single institution after adjusting for preoperative patient and tumor characteristics using propensity score matching (PSM). Methods: In this retrospective cohort study, patients who underwent RAPN or OPN for a renal mass of cT1-2 N0 M0 between 2005 and 2020 at our institution were recruited. The study outcomes were perioperative outcomes, complications, and pathological and functional outcomes. PSM was used to account for baseline covariates. Results: Overall, 131 RAPN and 71 OPN cases were extracted; in addition, 58 cases of RAPN and OPN were selected via PSM. RAPN was superior to OPN in terms of estimated blood loss (10 g vs. 160 g, P < 0.001), ischemia time (23 min vs. 34 min, P < 0.001), and hospital duration (7 days vs. 12 days, P < 0.001). There were no significant differences in the incidence of perioperative complications or in the rate of positive surgical margins (both P > 0.05). With respect to functional outcomes, the rates of preservation of renal function at both 1 day and 3 months postoperatively were higher with RAPN than with OPN (85.3% vs. 69.1% and 93.3% vs. 85.6% respectively, both P < 0.001). Conclusion: In selected cases, RAPN with warm ischemia appears to preserve renal function equally well or better compared to OPN with cold ischemia.
Highlights
Partial nephrectomy (PN) for localized renal cell carcinoma has been reported to have oncological outcomes equivalent to those achieved by radical nephrectomy, with preservation of postoperative renal function[1,2]
A total of 116 cases were compared, comprising 58 Robot-assisted partial nephrectomy (RAPN) cases and 58 open partial nephrectomy (OPN) cases that were matched by propensity score matching (PSM)
In the post-PSM cohort, there were no differences between the RAPN and OPN groups for any of the covariates assessed [Figure 1]
Summary
Partial nephrectomy (PN) for localized renal cell carcinoma has been reported to have oncological outcomes equivalent to those achieved by radical nephrectomy, with preservation of postoperative renal function[1,2]. Its application as an alternative to open partial nephrectomy (OPN) is rapidly growing[3,4]. This is largely due to RAPN’s high-definition 3D optical system and flexible wristed instruments that allow surgeons to perform tumor excision and renorrhaphy with an accuracy equal to or greater than that achieved by OPN[5]. Because the outcomes of PN are influenced by several factors, including tumor location, anatomical complexity, patient renal function, and operator proficiency, there is some controversy over which surgical approach is superior. Current guidelines do not indicate a preference for one technique over the other, leading to decisions being predominantly made on the basis of the surgeons’ expertise and skills[13]
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