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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.