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Robotic versus laparoscopic radical nephrectomy: a large multi-institutional analysis (ROSULA Collaborative Group)

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Abstract

Objective

To compare the outcomes of robotic radical nephrectomy (RRN) to those of laparoscopic radical nephrectomy (LRN) for large renal masses.

Methods

This was a retrospective analysis of RRN and LRN cases performed for large (≥ cT2) renal masses from 2004 to 2017 and collected in the multi-institutional international database (ROSULA: RObotic SUrgery for LArge renal masses). Peri-operative, functional, and oncologic outcomes were compared between each approach. Descriptive analyses were performed and presented as medians with interquartile ranges. Inverse probability of treatment weighting-adjusted multivariable analyses were used to identify predictors of peri-operative complications. Kaplan–Meier analysis and Cox regression models were used to assess survival outcomes.

Results

A total of 941 patients (RRN = 404, LRN = 537) were identified. There was no difference in terms of gender, age, and clinical tumor size. Over the study period, RRN had an annual increase of 11.75% (95% CI [7.34, 17.01] p < 0.001) and LRN had an annual decline of 5.39% (95% CI [−6.94, −3.86] p < 0.001). Patients undergoing RRN had higher BMI (27.6 [IQR 24.8–31.1] vs. 26.5 [24.1–30.0] kg/m2, p < 0.01). Operative duration was longer for RRN (185.0 [150.0–237.2] vs. 126 [90.8–180.0] min, p < 0.001). Length of stay was shorter for RRN (3.0 [2.0–4.0] vs. 5.0 [4.0–7.0] days, p < 0.001). RRN cases presented more advanced disease (higher pathologic staging [pT3–4 52.5 vs. 24.2%, p < 0.001], histologic grade [high grade 49.3 vs. 30.4%, p < 0.001], and rate of nodal disease [pN1 5.4 vs. 1.9%, p < 0.01]). Surgical approach did not represent an independent risk factor for peri-operative complications (OR 1.81 95% CI [0.97–3.39], adjusted p = 0.2). The main study limitation is the retrospective design.

Conclusions

This study represents the largest known multi-center comparison between RRN and LRN. The two procedures seem to offer similar peri-operative outcomes. Notably, RRN has been increasingly utilized, especially in the setting of more advanced and surgically challenging disease without increasing the risk of peri-operative complications.

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Author information

Authors and Affiliations

  1. Division of Urology, Virginia Commonwealth University School of Medicine, Richmond, VA, USA

    Uzoma A. Anele, Lance J. Hampton & Riccardo Autorino

  2. Department of Urology, SS Annunziata Hospital, “G.D’Annunzio” University of Chieti, Chieti, Italy

    Michele Marchioni, Luigi Schips & Francesco Berardinelli

  3. Department of Urology, Changhai Hospital, Shanghai, China

    Bo Yang & Chao Zhang

  4. Department of Urology, IRCCS - “Regina Elena” National Cancer Institute, Rome, Italy

    Giuseppe Simone & Michele Gallucci

  5. Division of Urology, Fox Chase Cancer Center, Philadelphia, PA, USA

    Robert G. Uzzo & Alexander Kutikov

  6. Division of Urology, City of Hope Medical Center, Duarte, CA, USA

    Clayton Lau & Patrick Kilday

  7. Department of Urology, Fundacion Instituto Valenciano Oncologia, Valencia, Spain

    Maria C. Mir & Miguel Ramirez-Backhaus

  8. Unit of Urology, Division of Oncology, Urological Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy

    Umberto Capitanio & Alessandro Larcher

  9. Swedish Urology Group, Seattle, WA, USA

    James Porter & Michael Liao

  10. Department of Urology, Medical College Wisconsin, Milwaukee, WI, USA

    Ken Jacobsohn & Peter Langenstroer

  11. Urology Centre, Guy’s and St Thomas’s NHS Foundation Trust, London, UK

    Nicolo de Luyk, Prokar Dasgupta & Ben Challacombe

  12. Department of Urology, University of Florence, Careggi Hospital, Florence, Italy

    Andrea Mari & Andrea Minervini

  13. Department of Urology, Yonsei Wonju, University College of Medicine, Wonju, Korea

    Kidon Chang & Koon Ho Rha

  14. Department of Urology, University of Turin-San Luigi Gonzaga Hospital, Turin, Italy

    Cristian Fiori & Francesco Porpiglia

  15. Department of Urology, Indiana University School of Medicine, Indianapolis, IN, USA

    Jay Sulek & Chandru P. Sundaram

  16. ORSI Academy, Melle, Belgium

    Alexandre Mottrie & Alessandro Larcher

  17. Department of Urology, OLV Hospital, Aalst, Belgium

    Alexandre Mottrie

  18. Department of Urology, University of Tennessee Medical Center, Knoxville, TN, USA

    Wesley White

  19. SC Urologia, Istituto Nazionale Tumori IRCCS, Fondazione Pascale, Napoli, Italy

    Sisto Perdona & Giuseppe Quarto

  20. Department of Urology, UC San Diego Health System, La Jolla, CA, USA

    Ahmet Bindayi & Ithaar Derweesh

  21. Institute of Urology, University of Southern California, Los Angeles, CA, USA

    Akbar Ashrafi & Monish Aron

  22. MRC Centre for Transplantation, NIHR Biomedical Research Centre, King’s College, London, UK

    Prokar Dasgupta

Authors
  1. Uzoma A. Anele
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  2. Michele Marchioni
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  3. Bo Yang
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  4. Giuseppe Simone
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  5. Robert G. Uzzo
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  6. Clayton Lau
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  7. Maria C. Mir
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  36. Chandru P. Sundaram
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  37. Lance J. Hampton
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  38. Francesco Porpiglia
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  39. Monish Aron
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  40. Ithaar Derweesh
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  41. Riccardo Autorino
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Contributions

Protocol/project development: RA, UAA, ID, FP. Data collection or management: UAA, MCM, NL, AM, KC, CF, JS, WW, GQ, AB, AA, FB, CZ, AL, PK, ML. Data analysis: UAA, MM. Manuscript writing: RA, UAA, ID. Manuscript editing: BY, GS, RGU, CL, MCM, UC, JP, AM, WW, SP, LS, MG, MR-B, CPS, AM, AK, KHR, PD, BC, LJH, FP, MA.

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Correspondence to Riccardo Autorino.

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The ROSULA database is an IRB-approved study at the participating centers.

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Patients included in this retrospective analysis had signed an informed consent at the time of surgery.

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Anele, U.A., Marchioni, M., Yang, B. et al. Robotic versus laparoscopic radical nephrectomy: a large multi-institutional analysis (ROSULA Collaborative Group). World J Urol 37, 2439–2450 (2019). https://doi.org/10.1007/s00345-019-02657-2

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