Comparison of robot‐assisted partial nephrectomy for complex (RENAL scores ≥10) and non‐complex renal tumors: A single‐center experience

Abstract

ObjectivesTo compare functional and surgical outcomes of robot‐assisted partial nephrectomy for complex tumors with RENAL scores ≥10 and non‐complex tumors at a single academic institution.MethodsWe retrospectively analyzed the data of all patients who underwent robot‐assisted partial nephrectomy at Kobe University Hospital (Kobe, Hyogo, Japan) from 2011 to 2020. Functional and surgical outcomes for complex tumors (RENAL score ≥10) were compared with those of patients with non‐complex tumors (RENAL <10). Outcomes analyzed included blood loss, warm ischemia time, console time, perioperative complications, and preoperative and postoperative renal function.ResultsA total of 348 patients were included in our present study, with a median follow‐up time of 35.1 months. Of these, 299 patients (85.9%) had non‐complex tumors and 49 patients (14.1%) had complex tumors. Warm ischemia time and console time were significantly longer in the complex tumors group. Major perioperative complications (Clavien–Dindo classification system ≥3) were significantly more frequent in the complex tumors group than the non‐complex tumor group (16.3% vs 5.7%, P = 0.018). Postoperative preservation of estimated glomerular filtration rate and percentage of chronic kidney disease upstage by 1 year were significantly inferior in the complex tumors group. The positive surgical margin rate was 0% and 0.3% in the complex and non‐complex tumor groups, respectively. There were no significant differences in recurrence‐free survival between the two groups (P = 0.11).ConclusionsRobot‐assisted partial nephrectomy for complex renal tumors is safe, with no difference in oncological outcomes, although more postoperative complications and decreased renal function can be observed than non‐complex tumors.