Open Versus Robot-Assisted Partial Nephrectomy: Effect on Clinical Outcome

Abstract

Robot-assisted partial nephrectomy (RPN) has emerged as a viable alternative to open partial nephrectomy (OPN) for small renal masses (SRMs). Comparative outcomes of RPN and OPN at a single institution were analyzed. A retrospective review was performed to compare 69 RPNs with 234 OPNs between May 2003 and December 2010 at a single institution. Clinicopathologic variables, operative parameters, and renal functional outcomes were analyzed. There were no significant differences between the two cohorts (RPN vs OPN) with respect to patient age (P=0.609), sex (P=0.703), preoperative estimated glomerular filtration rate (eGFR, P=0.146), estimated blood loss (P=0.600), and tumor size (P=0.256). The mean operative time was longer in the RPN group (192 vs 142 min, P<0.001). The mean warm ischemia time was longer in the RPN cohort (22.99 vs 18.87 min, P<0.001), but there were no significant differences in the postoperative eGFR (P=0.162) and change in the eGFR (P=0.520). The length of hospitalization (6.2 vs 8.9 d, P<0.001) and use of postoperative analgesics (ketoprofen, 0.26 vs 0.88 ampules, P<0.001) were more favorable in the RPN cohort. The number of patients with positive surgical margins was 0 for the RPN and 6 for the OPN groups. The intraoperative complication rates were 4.35% and 4.27% in the RPN and OPN groups, respectively (P=0.999). The overall postoperative complication rates were 8.7% and 15.4% in the RPN and OPN groups, respectively (P=0.158). RPN is a viable option as a nephron-sparing surgical procedure for SRMs considering the perioperative parameters and postoperative renal function changes, in addition to the traditional benefits of the laparoscopic procedure.