Robotic versus open partial nephrectomy for highly complex renal masses: Comparison of perioperative, functional, and...

We aimed to compare perioperative, functional and oncological outcomes between robot-assisted partial nephrectomy (RAPN) and open partial nephrectomy (OPN) for highly complex renal tumors (R.E.N.A.L. nephrometry Score > 9).

A retrospective review of 1,497 patients who consecutively underwent partial nephrectomy at a single academic tertiary center between 2008 and 2016 was performed to get data about patients who underwent RAPN and OPN for renal masses with RENAL score > 9. Baseline, perioperative, functional, and oncological outcomes were compared.

Two hundred and three RAPN and 76 OPN were extracted. Patients' demographics and tumors' characteristics were comparable between the groups. Blood loss (200 vs. 300 cc, P < 0.0001), intraoperative transfusion rates (3% vs. 15.8%, P < 0.001), and length of stay (3 vs. 5 days, P < 0.01) were lower for RAPN. A significant decrease in estimated glomerular filtration rate was observed from preoperative to postoperative period, regardless the approach (OPN, P = 0.026 vs. RAPN, P = 0.014). Conversion to radical nephrectomy was 7.8% and 5.9% for OPN and RAPN, respectively. At multivariable regression, open approach was predictive of intraoperative transfusion and reoperation. Overall actuarial rate of recurrence or metastasis was 4.3%, with 3 cancer-related deaths occurring after a median follow-up of 25 months. No differences were found between the groups.

In our large single-institutional series of patients who underwent partial nephrectomy for highly complex renal tumors, robotic approach appeared to be a valuable alternative to OPN, with the advantages of reduced blood loss, ischemia time, transfusions rate, and length of stay.