World Journal of Urology

, Volume 32, Issue 1, pp 287–293 | Cite as

Open versus robotic-assisted partial nephrectomy: a multicenter comparison study of perioperative results and complications

Original Article

Abstract

Purpose

To compare surgical results, morbidity and positive surgical margins rate of patients undergoing robotic partial nephrectomy (RPN) versus open partial nephrectomy (OPN).

Methods

This is an observational multicenter study promoted by the “Associazione GIovani Laparoscopisti Endoscopisti” (AGILE) no-Profit Foundation, which involved six Italian urologic centers. All clinical, surgical, and pathological variables of patients treated with OPN or RPN for renal tumors were gathered in a prospectively maintained database. Tumor nephrometry was measured with PADUA score, and complications were stratified with modified Clavien system. Differences between RPN and OPN group were assessed with univariate analysis. Perioperative variables independently associated with complications were assessed with multivariate analysis.

Results

A total of 198 and 105 patients were enrolled in OPN and RPN group, respectively. Both had similar demographics, indications to surgery, tumor nephrometry, renal function, WIT (18.7 vs. 18.2 min; p = NS), positive margin rate (5.6 vs. 5.7 %; p = NS), intraoperative complications, and postoperative medical complications. Compared to OPN, RPN group was significantly more morbid (p = 0.04), included tumors with smaller size (p = 0.002), had longer operative time (p < 0.001), lower blood loss, surgical postoperative complications (5.7 vs. 21.2 %, p < 0.001), Clavien 3–4 surgical complications (1 vs. 9.1 %, p = 0.001), and shorter hospitalization. The surgical approach resulted independently correlated with surgical complications on multivariate analysis.

Conclusion

In the present series, RPN was associated with a significant reduction of blood loss, surgical complications, including the reintervention rate for urinary fistula and postoperative bleeding, and with a shorter hospitalization.

Keywords

Kidney tumor Partial nephrectomy Robotics Complications 

Abbreviations

I postop./III postop.

First/third postoperative day

ASA

American Society of Anaesthesiologists

BMI

Body mass index

EBL

Estimated blood loss (during surgery)

ECOG

Eastern cooperative oncology group

IQR

Interquartile range

LOS

Length of hospital stay

OPN

Open partial nephrectomy

PB

Postoperative bleeding

PN

Partial nephrectomy

PSM

Positive surgical margins

RPN

Robotic partial nephrectomy

RCC

Renal cell carcinoma

RR

Related risk

SD

Standard deviation

UCS

Urinary collecting system

UF

Urinary fistula

WIT

Warm ischemia time

Notes

Conflict of interest

None.

References

  1. 1.
    Ljungberg B, Cowan NC, Hanbury DC et al. (2010) European association of urology guideline group. EAU guidelines on renal cell carcinoma: the 2010 update. Eur Urol 58(3):398–406. Epub 2010 Jul 12. PubMed PMID: 20633979Google Scholar
  2. 2.
    Novick AC, Campbell SC, Belldegrun A et al: Guideline for management of the clinical stage 1 renal mass. Available at www.auanet.org/content/ media/renalmass09.pdf?CFID 1666475&CFTOKEN 79651347&jsessionid 8430e85e87e2ad1bac0325294 a7325226072. Accessed 1 Aug 2010
  3. 3.
    Antonelli A, Ficarra V, Bertini R et al (2012) Members of the SATURN Project—LUNA Foundation. Elective partial nephrectomy is equivalent to radical nephrectomy in patients with clinical T1 renal cell carcinoma: results of a retrospective, comparative, multi-institutional study. BJU Int 109(7):1013–1018PubMedCrossRefGoogle Scholar
  4. 4.
    Huang WC, Elkin EB, Levey AS et al (2009) Partial nephrectomy versus radical nephrectomy in patients with small renal tumors–is there a difference in mortality and cardiovascular outcomes? J Urol 181(1):55–61PubMedCentralPubMedCrossRefGoogle Scholar
  5. 5.
    Miller DC, Schonlau M, Litwin MS et al (2008) Urologic diseases in America project. Renal and cardiovascular morbidity after partial or radical nephrectomy. Cancer 112(3):511–520PubMedCrossRefGoogle Scholar
  6. 6.
    Khalifeh A, Autorino R, Hillyer SP et al. (2013) Comparative outcomes and assessment of “Trifecta” in 500 robotic and laparoscopic partial nephrectomies: a single surgeon experience. J Urol 189(4):1236–1242 Google Scholar
  7. 7.
    Benway BM, Bhayani SB, Rogers CG et al (2009) Robot assisted partial nephrectomy versus laparoscopic partial nephrectomy for renal tumors: a multi-institutional analysis of perioperative outcomes. J Urol 182(3):866–872PubMedCrossRefGoogle Scholar
  8. 8.
    Pierorazio PM, Patel HD, Feng T, et al. (2011) Robotic-assisted versus traditional laparoscopic partial nephrectomy: comparison of outcomes and evaluation of learning curve. Urology 78(4):813–819. Epub 2011 Jul 29Google Scholar
  9. 9.
    Simhan J, Smaldone MC, Tsai KJ et al (2012) Perioperative outcomes of robotic and open partial nephrectomy for moderately and highly complex renal lesions. J Urol 187(6):2000–2004PubMedCrossRefGoogle Scholar
  10. 10.
    Sprenkle PC, Power N, Ghoneim T et al (2012) Comparison of open and minimally invasive partial nephrectomy for renal tumors 4–7 centimeters. Eur Urol 61(3):593–599PubMedCrossRefGoogle Scholar
  11. 11.
    Lee S, Oh J, Hong SK, et al. (2011) Open versus robot-assisted partial nephrectomy: effect on clinical outcome. J Endourol 25(7):1181–1185. Epub 2011 Jun 9Google Scholar
  12. 12.
    Mottrie A, De Naeyer G, Schatteman P et al (2010) Impact of the learning curve on perioperative outcomes in patients who underwent robotic partial nephrectomy for parenchymal renal tumours. Eur Urol 58(1):127–132PubMedCrossRefGoogle Scholar
  13. 13.
    Ficarra V, Novara G, Secco S et al (2009) Preoperative aspects and dimensions used for an anatomical (PADUA) classification of renal tumours in patients who are candidates for nephron-sparing surgery. Eur Urol 56(5):786–793PubMedCrossRefGoogle Scholar
  14. 14.
    Levey AS, Stevens LA, Schmid CH et al (2009) A new equation to estimate glomerular filtration rate. Ann Intern Med 150(9):604–612PubMedCentralPubMedCrossRefGoogle Scholar
  15. 15.
    Greene FL, Gospodarowicz M, Wittekend C et al (2009) American joint committee on cancer (AJCC) staging manual, 7th edn. Springer, PhiladelphiaGoogle Scholar
  16. 16.
    Fuhrman SA, Lasky LC, Limas C (1982) Prognostic significance of morphologic parameters in renal cell carcinoma. Am J Surg Pathol 6:655–663PubMedCrossRefGoogle Scholar
  17. 17.
    Eble JN, Sauter G, Epstein JI et al (2004) Pathology and genetics of tumours of the urinary system and male genital organs. World health organization classification of tumours. IARC Press, LyonGoogle Scholar
  18. 18.
    Dindo D, Demartines N, Clavien PA (2004) Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 240:205–213PubMedCrossRefGoogle Scholar
  19. 19.
    Wang AJ, Bhayani SB (2009) Robotic partial nephrectomy versus laparoscopic partial nephrectomy for renal cell carcinoma: single-surgeon analysis of 100 consecutive procedures. Urology 73:306–310PubMedCrossRefGoogle Scholar
  20. 20.
    Kural AR, Atug F, Tufek I et al (2009) Robot-assisted partial nephrectomy versus laparoscopic partial nephrectomy: comparison of outcomes. J Endourol 23:1491–1497PubMedCrossRefGoogle Scholar
  21. 21.
    Rogers CG, Patard JJ (2009) Rebuttal 2 open to debate. The motion: robotic partial nephrectomy is better than open partial nephrectomy. Eur Urol 56(3):568–570. Epub 2009 Jun 24Google Scholar
  22. 22.
    Pasticier G, Timsit MO, Badet L et al (2006) Nephron-sparing surgery for renal cell carcinoma: detailed analysis of complications over a 15-year period. Eur Urol 49(3):485–490PubMedCrossRefGoogle Scholar
  23. 23.
    Campbell SC, Novick AC, Streem SB et al (1994) Complications of nephron sparing surgery for renal tumors. J Urol 151(5):1177–1180PubMedGoogle Scholar
  24. 24.
    Thompson RH, Leibovich BC, Lohse CM et al (2005) Complications of contemporary open nephron sparing surgery: a single institution experience. J Urol 174(3):855–858PubMedCrossRefGoogle Scholar
  25. 25.
    Dulabon LM, Kaouk JH, Haber GP et al (2011) Multi-institutional analysis of robotic partial nephrectomy for hilar versus nonhilar lesions in 446 consecutive cases. Eur Urol 59(3):325–330PubMedCrossRefGoogle Scholar
  26. 26.
    Gupta GN, Boris R, Chung P et al (2011) Robot-assisted laparoscopic partial nephrectomy for tumors greater than 4 cm and high nephrometry score: feasibility, renal functional, and oncological outcomes with minimum 1 year follow-up. Urol Oncol 31:51–56PubMedCentralPubMedCrossRefGoogle Scholar
  27. 27.
    Van Poppel H, Bamelis B, Oyen R, Baert L (1998) Partial nephrectomy for renal cell carcinoma can achieve long-term tumor control. J Urol 160(3 Pt 1):674–678PubMedGoogle Scholar
  28. 28.
    Stephenson AJ, Hakimi AA, Snyder ME, Russo P (2004) Complications of radical and partial nephrectomy in a large contemporary cohort. J Urol 171(1):130–134PubMedCrossRefGoogle Scholar
  29. 29.
    Pomara G, Campo G, Francesca F (2009) Intraoperative and postoperative complications of nephron sparing surgery: prevention and possible treatments. Arch Ital Urol Androl 81(2):80–85 ReviewPubMedGoogle Scholar
  30. 30.
    Minervini A, Vittori G, Salvi M et al (2013) Analysis of surgical complications of renal tumor enucleation with standardized instruments and external validation of PADUA classification. Ann Surg Oncol 20(5):1729–1736PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2013

Authors and Affiliations

  1. 1.Clinica Urologica I, Azienda Ospedaliera CareggiUniversità di FirenzeFlorenceItaly

Personalised recommendations