Robot-assisted versus laparoscopic partial nephrectomy for anatomically complex T1b renal tumors with a RENAL nephrometry score≥7: A propensity score-based analysis.

Wen Deng,Luyao Chen,Junhua Li,Bin Fu,Xiaoqiang Liu,Jingyu Zhu,Weipeng Liu,Gongxian Wang,Xiaochen Zhou

doi:10.1002/cam4.2749

Abstract

ObjectivesTo present the perioperative, functional, and oncological outcomes of robot‐assisted partial nephrectomy (RPN) compared with laparoscopic partial nephrectomy (LPN) for anatomically complex T1b renal tumors with RENAL nephrometry scores ≥7.Patients and methodsOne hundred and seventy patients, during the study period, were retrospectively reviewed in our analysis according to inclusion criteria. Propensity score matching (PSM) (1:1) method was applied to impose restrictions on the potential baseline confounders. The comparisons of perioperative and functional outcomes between the RPN and LPN groups were conducted and analyzed after PSM, Kaplan‐Meier analyses were performed to assess the differences about oncological outcomes between the two groups before and after PSM.ResultsOne hundred and nine and 61 T1b renal tumors with RENAL scores ≥7 were identified in the LPN and RPN groups, respectively. All significant differences in baseline characteristics disappeared after PSM. Except for 3 patients missing an appropriate pair, all the patients in the RPN group were successfully matched to 58 patients in the LPN group in a 1:1 ratio. Within the matched cohort, the RPN group was related to a significantly shorter mean operating time (OT) (P = .040), shorter mean warm ischemia time (WIT) (P = .023), and shorter median postoperative hospital stay (P = .023). The possibilities of surgical conversion, postoperative complication, and positive surgical margin were similar in the LPN and RPN groups. And there was also no significant difference in the pathological, renal functional, and oncological outcomes between the two series.ConclusionsFor patients with anatomically complex T1b renal tumors with a RENAL nephrometry score ≥7, RPN had an advantage over LPN in reducing OT, WIT, and postoperative hospital stay length without increasing the risk of complications and weakening the oncological control, while the two surgical methods were similar in renal functional preservation.

Highlights

Depending on the advantage in better renal functional preservation without compromising the oncological control, partial nephrectomy (PN) has been strongly recommended as the standard surgical method for T1a or even T1b renal tumors when technically feasible.[1]
No study concentrated on comparing laparoscopic PN (LPN) and robot-assisted PN (RPN) for anatomically complex T1b renal tumors with a RENAL nephrometry score ≥7 before, which was of great importance and remained debated.[14]
We present the first comparison of the perioperative, functional, and oncological outcomes between LPN and RPN for anatomically complex T1b renal tumors with a RENAL nephrometry score ≥7 before and after the propensity score matching (PSM)

Summary

Introduction

Depending on the advantage in better renal functional preservation without compromising the oncological control, partial nephrectomy (PN) has been strongly recommended as the standard surgical method for T1a or even T1b renal tumors when technically feasible.[1]. The main advantages consisting of the three-dimensional (3D) magnified vision of the surgical field, improved dexterity, and higher precision in the surgical procedure made RPN a great evolution of LPN.[7,9] Many studies had demonstrated the safety and efficiency of RPN for complex renal tumors,[9,10,11,12,13] but most tumors in all these studies were in small size (≤4 cm) and these evidences were insufficient about oncological outcomes. No study concentrated on comparing LPN and RPN for anatomically complex T1b renal tumors with a RENAL nephrometry score ≥7 before, which was of great importance and remained debated.[14] In the current study, we present the first comparison of the perioperative, functional, and oncological outcomes between LPN and RPN for anatomically complex T1b renal tumors with a RENAL nephrometry score ≥7 before and after the propensity score matching (PSM)

Objectives

Results

Conclusion