Robot-assisted partial nephrectomy for large renal masses: a multi-institutional series.

Area of Science:

• Urology
• Oncology
• Minimally Invasive Surgery

Background:

• Robot-assisted partial nephrectomy (RAPN) is increasingly used for renal tumors.
• Outcomes for larger tumors (cT2a) compared to smaller ones (cT1) require further investigation.

Purpose of the Study:

• To compare peri-operative outcomes of RAPN for cT2a renal masses (7 to <10 cm) versus cT1a and cT1b renal masses.

Main Methods:

• A multi-institutional database of RAPN cases was queried.
• Patients with cT1a, cT1b, or cT2a renal masses were identified.
• Multivariable regression models were used to compare outcomes, adjusting for surgeon and a modified R.E.N.A.L. nephrometry score.

Main Results:

• RAPN for cT2a vs cT1a masses showed increased operating time (+12%), blood loss (+32%), ischemia time (+7%), and higher odds of acute kidney injury.
• RAPN for cT2a vs cT1b masses showed increased blood loss (+12%) and operating time (+5%).
• No significant differences were observed in complication rates, positive margins, or length of stay between cT2a and cT1 groups. However, cT2a tumors had a significantly higher risk of recurrence (HR 10.9 vs cT1a; HR 11.2 vs cT1b).

Conclusions:

• RAPN is a feasible option for select cT2a renal tumors in experienced hands, despite longer operative times and increased blood loss.
• While short-term complications and renal function are comparable to T1 tumors, the significantly higher recurrence rate in cT2a cases warrants careful consideration.
• Extended follow-up is crucial to assess long-term survival outcomes for cT2a tumors treated with RAPN.