Robot-assisted vs open partial nephrectomy: a propensity-matched analysis of perioperative outcomes and midterm...

Partial nephrectomy (PN) is preferred treatment for localized renal cell carcinoma (RCC), with shift toward robotic-assisted PN (RAPN) over open PN (OPN). However, high-quality comparative data remain limited. This study aimed to compare intraoperative, perioperative, and oncologic outcomes of RAPN versus OPN using a propensity score-matched cohort.

In this retrospective, single-centre study, 386 patients underwent PN between January 2020 and December 2024. After applying exclusion criteria and propensity-score matching, 152 OPN cases were matched with 125 RAPN. Matching variables included age, Charlson Comorbidity Index, RENAL and PADUA scores, cT stage, and location. Primary endpoint was the intraoperative complication rate. Secondary endpoints included estimated blood loss (EBL), operative time, warm-ischemia time, length of hospital stay (LOS), postoperative complications rate (Clavien-Dindo classification), and 5-year oncologic outcomes (overall-survival [OS], cancer-specific survival [CSS], and recurrence-free survival [RFS]).

RAPN was associated with a lower intraoperative complication rate compared to OPN (2% vs. 10%, p = 0.003). RAPN resulted in lower EBL (200 mL vs. 300 mL, p = 0.001), shorter operative time (147 vs. 170 min, p = 0.001), and reduced LOS (median 6 days, p = 0.001). Postoperative complications were less frequent with RAPN (14% vs. 25%, p = 0.01), with no significant differences in severe complications or positive surgical margins. Five-year OS, CSS, and RFS were similar between groups.

RAPN provides significant perioperative advantages over OPN without compromising oncologic safety at 5 years. These findings support broader adoption of RAPN in selected patients. Multicenter studies are warranted to assess cost-effectiveness, long-term functional outcomes, and generalizability.