You have accessJournal of UrologyCME1 May 2022PD37-10 COMPARATIVE ANALYSIS OF FUNCTIONAL OUTCOMES OF OPEN, LAPAROSCOPIC AND ROBOTIC PARTIAL NEPHRECTOMY STRATIFIED BY TUMOR COMPLEXITY: A MULTI-CENTER STUDY Ava Saidian, Arman Walia, Juan Javier-Desloges, and Ithaar Derweesh Ava SaidianAva Saidian More articles by this author , Arman WaliaArman Walia More articles by this author , Juan Javier-DeslogesJuan Javier-Desloges More articles by this author , and Ithaar DerweeshIthaar Derweesh More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002595.10AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Partial nephrectomy (PN) for localized renal masses has become standard of care, though impact of surgical approach [open (OPN) vs. laparoscopic (LPN) vs. robotic (RPN)] as it relates to tumor complexity remains controversial. We sought to evaluate the impact of RENAL score and surgical approach on functional outcomes. METHODS: Multi-institutional retrospective analysis of PN performed between 2000–2016. The cohort was divided into OPN vs. LPN vs. RPN approach, and descriptive analyses were conducted. Primary outcome was developed of new onset CKD (defined as eGFR <45 mL/min/1.73 m2). multivariable binary logistic regression (MVA) was performed to identify predictors of de novo CKD. Multivariable linear regression was conducted for delta eGFR (ΔeGFR) comparing OPN vs. LPN vs. RPN approaches based on RENAL score category. RESULTS: 3,525 patients were included: 1,465 (41.56%) underwent OPN, 536 (15.21%) had LPN, and 1524 (43.23%) underwent RPN. Multivariable binary logistic regression assessing predictors of de novo CDK <45 stratified by RENAL score group found that in the low complexity group: increasing age (OR 1.059, p=0.013) was positively associated, while increasing preoperative eGFR (OR 0.932, p <0.001), and RPN (OR 0.36, p=0.032) were negatively associated. In the intermediate complexity group: increasing BMI (OR 1.079, p=0.053) was positively associated, while increasing preoperative eGFR (OR 0.881, p <0.001) was negatively associated with de novo CKD. For the high complexity group: only increasing preoperative eGFR was negatively associated (OR 0.866, p=0.022). Multivariable linear regression assessing predictors of ΔeGFR by RENAL score category found for low complexity tumors: age (B −0.124, p <0.001), preoperative eGFR (B −0.386, p <0.001), diabetes (DM, B −4.681, p <0.001) were associated with a larger decrease in ΔeGFR. In intermediate complexity tumors: age (B −0.114, p=0.004), preoperative eGFR (B −0.398, p <0.001), DM (B −5.783, p <0.001), BMI (B −0.238, p=0.013) are associated with larger ΔeGFR, while robotic approach (B 2.391, p=0.013) is associated with smaller ΔeGFR. In high complexity tumors: age (B −0.296, p=0.17) and preoperative eGFR (B −0.433, p <0.001) were associated with larger ΔeGFR. CONCLUSIONS: RPN is not associated with worsened renal functional outcomes, even amongst high RENAL score complexity tumors. In experienced hands, RPN may be considered as a viable option in patients with increasingly complex masses in whom preservation of renal function is imperative and where functional reserve may be limited. Source of Funding: N/A © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e643 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Ava Saidian More articles by this author Arman Walia More articles by this author Juan Javier-Desloges More articles by this author Ithaar Derweesh More articles by this author Expand All Advertisement PDF DownloadLoading ...