Comparison by Pentafecta Criteria of Transperitoneal and Retroperitoneal Robotic Partial Nephrectomy for Large Renal...

To compare and analyze surgical and functional outcomes of transperitoneal robotic partial nephrectomy (TRPN) and retroperitoneal robotic partial nephrectomy (RRPN) in localized renal tumors, including ≥4 cm renal masses. Of 566 consecutive patients who underwent robotic partial nephrectomy by a single surgeon from December 2008 through July 2017, records for 523 patients who were preoperatively and 1 year postoperatively evaluated were analyzed for estimated glomerular filtration rate (eGFR). Primary endpoint was a comparison of Pentafecta criteria (negative surgical margin, no 30-day complications, warm ischemic time [WIT] ≤25 minutes, return of eGFR to >90% from baseline, and no upstaging of chronic kidney disease) between TRPN and RRPN. Secondary endpoint was finding predictors for Pentafecta achievement. In all 523 patients, these Pentafecta criteria were lower for RRPN than TRPN: operation time (p < 0.001), WIT (p = 0.008), and estimated blood loss (p = 0.003). In patients with ≥4 cm renal tumors, only operation time was faster in RRPN than TRPN (p = 0.032). RRPN demonstrated more eGFR decrease in all patients (p = 0.006) and patients with ≥4 cm renal tumors (p = 0.008). Pentafecta achievements, complications, and recurrences were not significantly different between TRPN and RRPN in all patients and patients with ≥4 cm renal tumors. Multivariable analysis revealed baseline hemoglobin (p = 0.013) and tumor size (p < 0.001) were predictive for Pentafecta achievement. Pentafecta achievement was similar for TRPN and RRPN. Baseline hemoglobin and tumor size were predictors of Pentafecta achievement. RRPN was properly performed for anterolateral renal tumor.