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Partial or radical nephrectomy for complex renal mass: a comparative analysis of oncological outcomes and complications from the ROSULA (Robotic Surgery for Large Renal Mass) Collaborative Group

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Abstract

Purpose

To compare outcomes of robotic-assisted partial nephrectomy (RAPN) and minimally invasive radical nephrectomy (MIS-RN) for complex renal masses (CRM).

Methods

We conducted a retrospective multicenter analysis of CRM patients who underwent MIS-RN and RAPN. CRM was defined as RENAL score 10–12. Primary outcome was overall survival (OS). Secondary outcomes were cancer-specific survival (CSS), recurrence, and complications. Multivariable analysis (MVA) and Kaplan–Meier Analysis (KMA) were used to analyze functional and survival outcomes for RN vs. PN by pathological stage.

Results

926 patients were analyzed (MIS-RN = 437/RAPN = 489; median follow-up 24.0 months). MVA demonstrated lack of transfusion (HR = 1.63, p = 0.005), low-grade (HR = 1.18, p = 0.018) and smaller tumor size (HR = 1.05, p < 0.001) were associated with OS. Younger age (HR = 1.01, p = 0.017), high-grade (HR = 1.18, p = 0.017), smaller tumor size (HR = 1.05, p < 0.001), and lack of transfusion (HR = 1.39, p = 0.038) were associated with CSS. Increasing tumor size (HR = 1.18, p < 0.001), high-grade (HR = 3.21, p < 0.001), and increasing age (HR = 1.02, p = 0.009) were independent risk factors for recurrence. Type of surgery was not associated with major complications (p = 0.094). For KMA of MIS-RN vs. RAPN for pT1, pT2 and pT3, 5-year OS was 85% vs. 88% (p = 0.078); 82% vs. 80% (p = 0.442) and 84% vs. 83% (p = 0.863), respectively. 5-year CSS was 98% for both procedures (p = 0.473); 94% vs. 92% (p = 0.735) and 91% vs. 90% (p = 0.581). 5-year non-CSS was 87% vs. 93% (p = 0.107); 87% for pT2 (p = 0.485) and 92% for pT3 for both procedures (p = 0.403).

Conclusion

RAPN in CRM is not associated with increased risk of complications or worsened oncological outcomes when compared to MIS-RN and may be preferred when clinically indicated.

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Data availability

All data generated or analyzed during this study are included in this article and its Tables, Figures and Supplementary Table. Further inquiries can be directed to the corresponding author.

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Funding

This work was supported by Stephen Weissmen Kidney Cancer Research Found (to Prof. IH Derweesh).

Author information

Author notes

  1. Riccardo Autorino

    Present address: Department of Urology, Rush University School of Medicine, Chicago, USA

Authors and Affiliations

  1. Department of Urology, UC San Diego School of Medicine, 3855 Health Sciences Drive, Mail Code 0987, La Jolla, CA, 92093-0987, USA

    Clara Cerrato, Devin Patel, Margaret F. Meagher, Dhruv Puri, Mimi Nguyen, Sohail Dhanji, Franklin Liu & Ithaar H. Derweesh

  2. Department of Urology, University of Verona, Azienda Ospedaliera Universitaria Integrata, Verona, Italy

    Clara Cerrato, Alessandro Antonelli & Maria Angela Cerruto

  3. Division of Urology, VCU Health System, Richmond, USA

    Riccardo Autorino & Savio D. Pandolfo

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

    Giuseppe Simone

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

    Bo Yang

  6. Division of Urology and Urologic Oncology, Fox Chase Cancer Center, Philadelphia, USA

    Robert Uzzo & Alexander Kutikov

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

    Francesco Porpiglia

  8. Unit of Urology, IRCCS San Raffaele Scientific Institute, Urological Research Institute (URI) Division of Experimental Oncology, Vita-Salute San Raffaele, University, Milan, Italy

    Umberto Capitanio & Francesco Montorsi

  9. Swedish Urology Group, Seattle, USA

    James Porter

  10. Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, USA

    Alp Tuna Beksac & Jihad Kaouk

  11. Department of Urology, University of Florence, Florence, Italy

    Andrea Minervini

  12. Division of Urology and Urologic Oncology, City of Hope Medical Center, Duarte, USA

    Clayton Lau

  13. Institute of Urology, University of Southern California Keck School of Medicine, Los Angeles, USA

    Akbar Ashrafi & Inderbir S. Gill

  14. Department of Urology, Lewis Katz School of Medicine at Temple University, Philadelphia, USA

    Daniel Eun

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

    Alexandre Mottrie

  16. Department of Urology, IMED Hospitals, Valencia, Spain

    Carmen Mir

  17. Department of Urology, Indiana University Health, Indianapolis, USA

    Chandru Sundaram

Authors
  1. Clara Cerrato
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Contributions

CC, IHD, DP: project conceptualization and development. DP, MFM, MN, SD, DP, FL, SDP: data collection or management. CC, IHD, MN, MFM: data analysis. CC, IHD: original draft writing/editing. GS, BY, RU, FP, UC, JP, ATB, AM, AA, MAC, CL, AA, DE, AM, CM, AK, FM, ISG, CS, JK: other: critical manuscript revision. IHD, RA: supervision.

Corresponding author

Correspondence to Ithaar H. Derweesh.

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Cerrato, C., Patel, D., Autorino, R. et al. Partial or radical nephrectomy for complex renal mass: a comparative analysis of oncological outcomes and complications from the ROSULA (Robotic Surgery for Large Renal Mass) Collaborative Group. World J Urol 41, 747–755 (2023). https://doi.org/10.1007/s00345-023-04279-1

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