Robot-assisted versus laparoscopic partial nephrectomy for multiple ipsilateral renal tumours: surgical, functional...

This study aimed to compare the outcomes of laparoscopic partial nephrectomy (LPN) and robot-assisted partial nephrectomy (RAPN) for the treatment of multiple ipsilateral renal tumours (MIRT). The primary outcomes were perioperative results, including the rate of postoperative complications and 'Trifecta' achievement. The secondary outcomes included renal functional preservation and oncological survival.

We retrospectively analysed the data of patients with MIRT who underwent LPN or RAPN between 2010 and 2024. Propensity score matching (1:1) was performed to adjust for potential baseline confounders, resulting in a final matched cohort of 19 patients per group. Perioperative data and functional, oncological, and survival outcomes were reviewed.

In the matched cohort, the RAPN group was associated with significantly fewer postoperative complications (10.5% vs. 47.4%, P = 0.029). Notably, 88.9% (8/9) of the complications in the LPN group were Clavien-Dindo grade I. The RAPN group also showed a higher 'Trifecta' rate (63.2% vs. 21.1%, P = 0.020) and shorter postoperative hospital stay (4 vs. 6 days; P = 0.044). At 12 months postoperatively, the RAPN group demonstrated significantly lower absolute (9.1 vs. 18.4 µmol/L, P = 0.041) and percentage changes (12.0% vs. 25.9%, P = 0.024) in serum creatinine (Scr). No significant differences were identified in disease-free survival (P = 0.386), cancer-specific survival (P = 0.678), or overall survival (P = 0.116).

For patients with MIRT, RAPN demonstrates superior perioperative results and better preservation of renal function compared to LPN. These findings support the use of robotics as the preferred minimally invasive strategy for complex cases with two ipsilateral renal lesions, potentially enhancing surgical safety and functional outcomes.