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Robotic and open partial nephrectomy for complex renal tumors: a matched-pair comparison with a long-term follow-up

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Abstract

Objectives

To compare the surgical, functional and oncological outcomes of patients undergoing robotic partial nephrectomy (RPN) or open partial nephrectomy (OPN) for moderately or highly complex tumors (RENAL nephrometry score ≥7).

Methods

A retrospective, matched-pair analysis was performed for 380 patients who underwent either RPN (n = 190) or OPN (n = 190) for a complex renal mass in different institutions. Surgical data, pathological variables, complications and functional and oncological outcomes were reviewed.

Results

RPN is associated with less estimated blood loss (EBL) (196.8 vs 240.8 ml; p < 0.001), shorter length of hospital stay (7.8 vs 9.2 days; p < 0.001) and lower rate of postoperative complications (15.8 vs 28.9 %; p = 0.002). Patients undergoing RPN required more direct cost. In multivariable models, surgical approach was the significant predictor for the occurrence of postoperative minor complications and postoperative wound pain. Median follow-up for RPN and OPN was 49 months and 52 months, respectively. The decline of estimated glomerular filtration at the last available follow-up (RPN: 8.7 %; OPN: 10 %) was similar (p = 0.125). The 5-year recurrence-free survival rate was 95.1 % for RPN and 92.7 % for OPN (p = 0.48).

Conclusions

RPN provides acceptable and comparable results in terms of perioperative, functional and oncological outcomes compared to OPN for complex renal tumors with RENAL score ≥7. Moreover, RPN is a less invasive approach with the benefit of shorter length of hospital stay, less EBL and lower rate of postoperative complications.

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Abbreviations

ASA:

American Society of Anesthesiologists

BMI:

Body mass index

CCI:

Charlson comorbidity index

CI:

Confidence interval

EBL:

Estimated blood loss

eGFR:

Estimated glomerular filtration rate

LPN:

Laparoscopic partial nephrectomy

MDRD:

Modification of diet in renal disease

OPN:

Open partial nephrectomy

OR:

Odds ratio

PN:

Partial nephrectomy

PSM:

Positive surgical margins

RFS:

Recurrence-free survival

RN:

Radical nephrectomy

RPN:

Robotic partial nephrectomy

SD:

Standard deviation

WIT:

Warm ischemia time

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Authors’ contribution

Yubin Wang and Xu Zhang developed the protocol/project; Yubin Wang, Jinkai Shao and Xin Ma contributed to the data collection or management; Qingshan Du and Huijie Gong analyzed the data; Yubin Wang and Qingshan Du wrote and edited the manuscript; Xu Zhang and Jinkai Shao reviewed the manuscript.

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Authors and Affiliations

  1. Department of Urology, Shanxi Provincial People’s Hospital, Taiyuan, 030001, China

    Yubin Wang & Jinkai Shao

  2. Department of Urology, Chinese People’s Liberation Army General Hospital, 28 Fuxing Road, Beijing, 100853, People’s Republic of China

    Xin Ma, Qingshan Du, Huijie Gong & Xu Zhang

Authors
  1. Yubin Wang
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  2. Jinkai Shao
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  3. Xin Ma
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  4. Qingshan Du
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  5. Huijie Gong
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  6. Xu Zhang
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Corresponding author

Correspondence to Xu Zhang.

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All authors certify that there is no actual or potential conflict of interest in relation to this article.

Ethical standards

The data were obtained from a prospectively maintained database approved by institutional review board and the local ethics committee, and informed consent was collected for all patients.

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Wang, Y., Shao, J., Ma, X. et al. Robotic and open partial nephrectomy for complex renal tumors: a matched-pair comparison with a long-term follow-up. World J Urol 35, 73–80 (2017). https://doi.org/10.1007/s00345-016-1849-8

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  • DOI: https://doi.org/10.1007/s00345-016-1849-8

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