Trifecta Outcomes in Renal Hilar Tumors: A Comparison Between Robotic and Open Partial Nephrectomy

Area of Science:

• Urology
• Surgical Oncology
• Minimally Invasive Surgery

Background:

• Renal hilar tumors present unique surgical challenges.
• Partial nephrectomy is the preferred treatment for localized renal tumors.
• Comparing open and robotic approaches is crucial for optimizing patient outcomes.

Purpose of the Study:

• To conduct a comparative analysis of outcomes between open and robotic partial nephrectomy for renal hilar tumors.
• To evaluate the efficacy and safety of robotic partial nephrectomy (RPN) against traditional open surgery.
• To identify differences in complication rates, oncological control, and renal function preservation.

Main Methods:

• Retrospective review of patients undergoing partial nephrectomy for renal hilar tumors (2011-2016).
• Definition of "trifecta" outcome: negative margins, no complications, and ≥90% glomerular filtration rate (GFR) preservation.
• Application of Inverse Probability of Treatment Weighting (IPTW) to control for confounding variables and minimize selection bias.

Main Results:

• After IPTW, no significant differences in baseline characteristics were observed between the robotic and open surgery groups.
• Robotic partial nephrectomy (RPN) demonstrated equivalent "trifecta" rates compared to open surgery (21.1% vs 13.9%, p=0.387).
• No significant differences in negative margin rates, complication absence, or GFR preservation were found. The robotic cohort experienced a shorter mean length of stay (3.8 vs 5.0 days, p=0.012).

Conclusions:

• Both open and robotic partial nephrectomy for renal hilar tumors yield comparable oncological and functional outcomes.
• The robotic approach offers a significant advantage in reducing hospital length of stay.
• RPN is a viable and effective alternative to open surgery for selected renal hilar tumors.