Retroperitoneal vs. transperitoneal robotic partial nephrectomy: a multicenter propensity-score matching analysis...

Area of Science:

• Urology
• Surgical Oncology
• Robotic Surgery

Background:

• Robot-assisted partial nephrectomy (RPN) is a key procedure for kidney cancer.
• Two primary surgical approaches exist: transperitoneal (TRPN) and retroperitoneal (RRPN).
• Comparative effectiveness of these approaches requires further investigation.

Purpose of the Study:

• To compare trifecta achievement rates between RRPN and TRPN.
• To evaluate secondary outcomes including operative time, blood loss, and complications.
• To analyze outcomes based on tumor location.

Main Methods:

• A large, multicenter, prospectively-maintained database was utilized.
• Propensity-score matching analysis compared patients undergoing TRPN and RRPN.
• The primary outcome was trifecta achievement (ischemia time < 25 min, negative margins, no major complications).

Main Results:

• After propensity-score matching (157 patients per group), trifecta rates were similar (TRPN 82.8% vs. RRPN 84.0%).
• RRPN demonstrated significantly shorter operative times and less blood loss compared to TRPN.
• RRPN showed a higher trifecta achievement rate for posterior tumors (P=0.017).

Conclusions:

• Robot-assisted retroperitoneal partial nephrectomy (RRPN) is a safe and effective alternative to the transperitoneal approach.
• RRPN is particularly advantageous for treating posterior renal tumors.
• The study supports RRPN as a viable option in partial nephrectomy.