Predictors of renal function after open and robot-assisted partial nephrectomy: A propensity score-matched study.

Abstract

To investigate parameters predicting short- and long-term renal function after open partial nephrectomy and robot-assisted partial nephrectomy. Medical records of 896 patients who underwent open partial nephrectomy or robot-assisted partial nephrectomy from 2004 to 2017 at a single large-volume institution were retrospectively reviewed. Propensity score matching of open partial nephrectomy and robot-assisted partial nephrectomy group was carried out with a ratio of 1:1. Postoperative outcomes were compared, and multivariate logistic regression was carried out to identify the parameters influencing acute kidney injury and chronic kidney disease progression. No significant differences in preoperative characteristics were observed between the two study groups after matching. Robot-assisted partial nephrectomy was significantly associated with a longer warm ischemic time (P<0.001) yet, estimated blood loss, positive surgical margin, rates of major postoperative complications and chronic kidney disease progression were significantly lower in the robot-assisted partial nephrectomy group (P<0.001, 0.033, <0.001, <0.001, and 0.005, respectively). Multivariate analysis showed robot-assisted partial nephrectomy was more favorable than open partial nephrectomy in terms of preserving renal function. Patients with a higher baseline estimated glomerular filtration rate were significantly associated with a greater risk of acute kidney injury (odds ratio 1.036; 95% confidence interval 1.021-1.052; P<0.001), but a decreased risk of chronic kidney disease progression (odds ratio 0.975; 95% confidence interval 0.955-0.994; P=0.011). Other independent predictors of chronic kidney disease progression were warm ischemic time (P=0.025), age (P=0.035), body mass index (P=0.041) and diabetes mellitus (P=0.035). Baseline estimated glomerular filtration rate, warm ischemic time and surgery type are independent predictors of both acute kidney injury and chronic kidney disease progression. Robot-assisted partial nephrectomy is more favorable than open partial nephrectomy for reducing estimated blood loss, positive surgical margin, major postoperative complications and renal function preservation.