Does size matter? Comparing robotic versus open radical nephrectomy for very large renal masses

Area of Science:

• Urology
• Surgical Oncology
• Nephrology

Background:

• Renal cell carcinoma (RCC) larger than 10 cm presents surgical challenges.
• Comparing robotic-assisted radical nephrectomy (RRN) with open radical nephrectomy (ORN) is crucial for optimizing outcomes in these cases.

Purpose of the Study:

• To evaluate perioperative and mortality outcomes of RRN versus ORN for very large (pT2b, >10 cm) non-metastatic renal cell carcinomas (RCC).

Main Methods:

• Analysis of adult patients with non-metastatic RCC >10 cm from the National Cancer Database (2010-2017).
• Used multivariable logistic regression and Kaplan-Meier/Cox modeling to compare RRN and ORN outcomes.
• Evaluated positive margins, prolonged length of stay (LOS), 30/90-day mortality, and overall survival (OS).

Main Results:

• RRN was associated with a decreased risk of prolonged LOS (OR 0.38) compared to ORN.
• No significant differences were found in positive margin rates, 30-day readmission, or 30/90-day mortality between RRN and ORN.
• Tumors ≥15.1 cm showed a higher rate of conversion to open surgery (P < 0.001).

Conclusions:

• Robotic-assisted radical nephrectomy (RRN) is a safe and effective treatment for very large, non-metastatic renal cell carcinomas (RCC).
• RRN offers comparable long-term survival and improved length of stay (LOS) compared to open radical nephrectomy (ORN).
• Higher conversion rates to open surgery were observed for tumors exceeding 15.1 cm.