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

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).

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.

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).

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.