Predicting complications in partial nephrectomy for T1a tumours: does approach matter?

Area of Science:

• Urology
• Surgical Oncology
• Minimally Invasive Surgery

Background:

• Partial nephrectomy is standard for T1a renal tumors.
• Robot-assisted partial nephrectomy (RAPN) and open partial nephrectomy (OPN) are surgical options.
• Surgeon experience may influence complication rates.

Purpose of the Study:

• To compare 30-day postoperative complication rates between RAPN and OPN.
• To identify predictors of complications in partial nephrectomy.
• To evaluate the impact of surgical approach on patient outcomes.

Main Methods:

• Retrospective analysis of patients with T1a renal tumors undergoing OPN or RAPN.
• Data collected from January 2011 to August 2015.
• Primary outcome: 30-day overall postoperative complications. Multivariable logistic regression used.

Main Results:

• OPN had a higher overall complication rate (30.3%) versus RAPN (18.2%; P=0.038).
• Wound complications were significantly more frequent after OPN (11.8% vs 1.8%; P<0.001).
• Open approach independently predicted higher overall complications (OR 1.58; P=0.035).

Conclusions:

• The open surgical approach is associated with increased complications for T1a renal tumors.
• Robot-assisted partial nephrectomy may offer improved outcomes for experienced surgeons.
• RAPN may incrementally reduce morbidity in nephron-sparing surgery.