Robotic versus laparoscopic radical nephrectomy: a large multi-institutional analysis (ROSULA Collaborative Group)

Area of Science:

• Urology
• Surgical Oncology
• Minimally Invasive Surgery

Background:

• Large renal masses (≥ cT2) present surgical challenges.
• Robotic radical nephrectomy (RRN) and laparoscopic radical nephrectomy (LRN) are common surgical approaches.
• Comparative outcomes data for these techniques in large renal masses are crucial.

Purpose of the Study:

• To compare peri-operative, functional, and oncologic outcomes of RRN versus LRN for large renal masses.
• To evaluate the increasing utilization trends of RRN in complex cases.
• To identify predictors of peri-operative complications in radical nephrectomy procedures.

Main Methods:

• Retrospective analysis of 941 patients undergoing RRN or LRN for large renal masses (2004-2017).
• Data collected from a multi-institutional international database (ROSULA).
• Inverse probability of treatment weighting-adjusted analyses and survival analyses were performed.

Main Results:

• RRN showed an increasing trend, while LRN declined over the study period.
• RRN cases had higher BMI and longer operative duration but shorter hospital stays.
• Despite RRN cases presenting more advanced disease, surgical approach was not an independent risk factor for complications.

Conclusions:

• RRN and LRN demonstrate comparable peri-operative outcomes for large renal masses.
• RRN adoption is increasing, particularly for surgically complex and advanced disease.
• The study highlights RRN's role in managing challenging renal masses without increased peri-operative risk.