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A comparative analysis of pre-operative factors, intra-operative events and post-operative outcomes assessing transperitoneal and retroperitoneal approaches for robotic partial nephrectomy in T1 renal cancer: a multicenter international experience

  • 0Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY, USA. modassarawan@gmail.com.
Journal of Robotic Surgery +

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September 1, 2025

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September 1, 2025

View abstract on PubMed

Summary

This summary is machine-generated.

Robot-assisted transperitoneal partial nephrectomy (RATP-PN) and robot-assisted retroperitoneal partial nephrectomy (RARP-PN) show comparable oncological and renal function outcomes. RARP-PN had shorter operative times and warm ischemia, while RATP-PN had higher blood loss. Advanced age predicts other-cause mortality in both approaches.

Area Of Science

  • Urology
  • Oncology
  • Surgical Technology

Background

  • Robot-assisted partial nephrectomy (PN) is a standard treatment for T1 renal cancer.
  • Transperitoneal (RATP) and retroperitoneal (RARP) approaches are common surgical routes.
  • Comparative analysis of these approaches is crucial for optimizing patient outcomes.

Purpose Of The Study

  • To compare preoperative factors, intraoperative events, and postoperative outcomes of RATP-PN and RARP-PN.
  • To assess the correlation between patient/tumor characteristics and surgical outcomes in T1 renal cancer.

Main Methods

  • Retrospective analysis of 2609 patients undergoing RATP or RARP partial nephrectomy over 10 years.
  • Comparison of preoperative factors (age, BMI, tumor size/stage, PADUA score, eGFR), intraoperative events (operative time, warm ischemia time, estimated blood loss), and postoperative outcomes (complications, eGFR, surgical margins, survival rates).
  • Statistical analysis to identify predictors of complications and mortality.

Main Results

  • RATP-PN patients were younger; tumor size was smaller in RARP-PN.
  • RATP-PN had significantly longer operative time (103 vs. 86 min) and warm ischemia time (23 vs. 10 min) (p < 0.001).
  • Estimated blood loss was higher in RATP-PN and for T1b tumors; RARP-PN had slightly more severe complications (Clavien-Dindo ≥3a).
  • Renal function (eGFR) and survival rates were similar at 40 months follow-up.
  • Advanced age predicted death from other causes (DOC); high PADUA score predicted death from disease (DOD) in T1a tumors.

Conclusions

  • Both RATP-PN and RARP-PN offer comparable oncological and functional outcomes for T1 renal cancer.
  • RARP-PN demonstrates advantages in operative time and warm ischemia time, while RATP-PN is associated with higher blood loss.
  • Patient age is a significant predictor of mortality from causes other than cancer, irrespective of surgical approach.

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