Long-term oncological and functional outcomes comparing laparoscopic and robotic nephron-sparing surgery

Laparoscopic partial nephrectomy, and more recently the robotic surgery, has replaced open surgery due to lower postoperative morbidity. However, it is still unknown whether robotic surgery offers better long-term oncological and functional results compared to conventional laparoscopy.

A large retrospective cohort study was conducted including 324 partial nephrectomies. They were classified in two groups: laparoscopic surgery (n=164) and robotic surgery (n=160). Recurrence-free survival (RFS), cancer-specific survival (CSS) and overall survival (OS) were analysed in the oncological study. In the functional study, the variation in serum creatinine and glomerular filtration rate (GFR) was evaluated before and 6 months after surgery.

The mean tumour size was 30 mm in both groups. A RENAL score >9 was observed in 29 robotic cases (18.12%) and in 14 laparoscopic cases (8.54%), with an odds ratio (OR) of 1.96 (95% confidence interval (CI) = 1.24-3.14). The mean follow-up time was 56.5 months in the laparoscopic and 30.0 months in the robotic group. Just nine and ten recurrences (local, nodal or distant) were observed in the laparoscopic and robotic groups respectively, with no significant differences in all the oncological variables. The median variation in GFR at 6 months was -3.24 mL/min and -1.5 mL/min in each group, with no significant statistical nor clinical differences.

Robotic partial nephrectomy is more feasible in complex renal tumour compared to the laparoscopic technique with same long-term oncological and functional outcomes.