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Retroperitoneal versus transepritoneal robot-assisted partial nephrectomy for postero-lateral renal masses: an international multicenter analysis

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Abstract

Purpose

To assess the outcomes of retroperitoneal robot-assisted partial nephrectomy (r-RAPN) in a large cohort of patients with postero-lateral renal masses comparing to those of transperitoneal RAPN (t-RAPN).

Methods

Patients with posterior (R.E.N.A.L. score grading P) or lateral (grading X) renal mass who underwent RAPN in six high-volume US and European centers were identified and stratified into two groups according to surgical approach: r-RAPN (“study group”) and t-RAPN (“control group”). Baseline characteristics, intraoperative, and postoperative data were collected and compared.

Results

Overall, 447 patients were identified for the analysis. 231 (51.7%) and 216 (48.3%) patients underwent r-RAPN and t-RAPN, respectively. Baseline characteristics were not statistically significantly different between the groups. r-RAPN group reported lower median operative time (140 vs. 170 min, p < 0.001). No difference was found in ischemia time, estimated blood loss, and intraoperative complications. Overall, 47 and 54 postoperative complications were observed in r-RAPN and t-RAPN groups, respectively (20.3 vs. 25.1%, p = 0.9). 1 and 2 patients reported major complications (Clavien-Dindo ≥ III grade) in the retroperitoneal and transperitoneal groups (0.4 vs. 0.9%, p = 0.9). There was no difference in hospital re-admission rate, median length of stay, and PSM rate. Trifecta criteria were achieved in 90.3 and 89.2% of r-RAPN and t-RAPN, respectively (p = 0.7).

Conclusion

r-RAPN and t-RAPN offer similar postoperative, functional, and oncological outcomes for patients with postero-lateral renal tumors. Our analysis suggests an advantage for r-RAPN in terms of shorter operative time, whereas it does not confirm a difference in terms of length of stay, as suggested by previous reports.

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Funding

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Author information

Authors and Affiliations

  1. Division of Urology, VCU Health, Richmond, VA, 23298-0118, USA

    Umberto Carbonara, Fabio Crocerossa, Alessandro Veccia, Lance J. Hampton & Riccardo Autorino

  2. Department of Urology, University of Bari, Bari, Italy

    Umberto Carbonara

  3. Department of Urology, Temple University, Philadelphia, PA, USA

    Daniel Eun & Jennifer Lee

  4. Department of Urology, UCSD, San Diego, CA, USA

    Ithaar Derweesh, Devin Patel & Margaret Meagher

  5. Unit of Urology, IRCCS Ospedale San Raffaele, Milan, Italy

    Umberto Capitanio, Alessandro Larcher & Francesco Montorsi

  6. Division of Experimental Oncology, Urological Research Institute (URI), IRCCS Ospedale San Raffaele, Milan, Italy

    Umberto Capitanio, Alessandro Larcher & Francesco Montorsi

  7. Department of Urology, San Bassiano Hospital, Bassano del Grappa, Vicenza, Italy

    Antonio Celia

  8. Department of Urology, San Luigi Hospital, University of Turin, Orbassano, Italy

    Cristian Fiori, Enrico Checcucci, Daniele Amparore & Francesco Porpiglia

Authors
  1. Umberto Carbonara
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  2. Daniel Eun
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  3. Ithaar Derweesh
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  4. Umberto Capitanio
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  5. Antonio Celia
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  6. Cristian Fiori
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  7. Enrico Checcucci
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  8. Daniele Amparore
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  9. Jennifer Lee
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  11. Devin Patel
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  12. Margaret Meagher
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  13. Fabio Crocerossa
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  14. Alessandro Veccia
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  15. Lance J. Hampton
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  16. Francesco Montorsi
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  17. Francesco Porpiglia
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  18. Riccardo Autorino
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Contributions

UC: Project development, Data collection, Data analysis, and Manuscript writing/editing; DE: Critical revision of the manuscript; ID: Critical revision of the manuscript; UC: Critical revision of the manuscript; AC: Critical revision of the manuscript and Data collection. CF: Critical revision of the manuscript; EC: Critical revision of the manuscript; DA: Critical revision of the manuscript and Data collection. JL: Critical revision of the manuscript and Data collection. AL: Critical revision of the manuscript and Data collection. DP: Critical revision of the manuscript and Data collection. MM: Critical revision of the manuscript and Data collection. FC: Critical revision of the manuscript; AV: Critical revision of the manuscript and Data collection. LJH: Critical revision of the manuscript; FM: Critical revision of the manuscript; FP: Critical revision of the manuscript; RA: Critical revision of the manuscript and Supervision.

Corresponding author

Correspondence to Riccardo Autorino.

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Carbonara, U., Eun, D., Derweesh, I. et al. Retroperitoneal versus transepritoneal robot-assisted partial nephrectomy for postero-lateral renal masses: an international multicenter analysis. World J Urol 39, 4175–4182 (2021). https://doi.org/10.1007/s00345-021-03741-2

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  • DOI: https://doi.org/10.1007/s00345-021-03741-2

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