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Updated: Jan 16, 2026
Robot-Assisted Kidney Transplantation
Published on: July 19, 2021
Comparison of laparoscopic and robot-assisted partial nephrectomy for intermediate/high-complexity endophytic renal
Luyao Chen1,2, Sheng Li1, Fuchun Zheng1
1Jiangxi Provincial Key Laboratory of Urinary System Diseases, Department of Urology, The First Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, Jiangxi, China.
Purpose:
To compare operative, functional, and oncological outcomes between laparoscopic partial nephrectomy (LPN) and robot-assisted partial nephrectomy (RAPN) for intermediate/high-complexity (R.E.N.A.L. nephrometry score ≥ 7) endophytic renal tumors (ERTs) by propensity score matching (PSM) analysis.
Methods:
We retrospectively analyzed data from 191 patients who underwent LPN (n = 120) or RAPN (n = 71) between June 2011 and June 2021. PSM was performed in a 1:1 ratio to balance preoperative characteristics, resulting in 70 matched pairs. Operative, functional, and oncological outcomes were then compared. Univariate and multivariate logistic regression identified factors associated with a trifecta and pentafecta failure, and Kaplan-Meier survival analysis compared survival outcomes.
Results:
RAPN was associated with shorter median warm ischemia time (23.5 vs. 27.5 min, P < 0.001), higher trifecta achievement (60% vs. 30%, P < 0.001), and less eGFR decline at 48 h postoperatively (14.9 vs. 21.0 mL/min/1.73 m², P = 0.011) compared to LPN. There were no significant differences in other perioperative or pathology outcomes, and long-term renal function and survival outcomes were similar between the two groups. High complexity (R.E.N.A.L. nephrometry score range of 10 to 12) was an independent risk factor for trifecta (OR = 2.65; 95% CI, 1.16-6.07, P = 0.021) and pentafecta (OR = 2.65; 95% CI, 1.06-6.67, p = 0.038) failures. LPN was also an independent risk factor for trifecta failure (OR = 4.53; 95% CI, 2.11-9.76, P < 0.001) but not for pentafecta failure.
Conclusion:
RAPN demonstrates better efficacy than LPN in protecting short-term renal function and achieving trifecta, while maintaining comparable long-term outcomes in intermediate/high-complexity ERTs. The high complexity was a significant independent risk factor for failing to achieve both trifecta and pentafecta.
