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Comparing surgical outcomes between minimally invasive and open surgery for tumors larger than 7 cm in the perirenal
Jia-Zi Shi1, Zong-Qin Zhang1, Mei-Zhu Xu2
1Department of Urology, The Second Affiliated Hospital of Naval Medical University, Shanghai, China.
Background:
To compare the peri-operative outcomes between the minimally-invasive surgery (MIS) and open surgery for the resection of perirenal tumors larger than 7 cm.
Methods:
This retrospective single-center study included 46 patients who underwent resection of retroperitoneal perirenal tumors larger than 7 cm between April 2009 and March 2025. Patients were stratified into MIS (laparoscopic or robot-assisted; n = 26) and open surgery (n = 20) groups. Demographic, peri-operative, and pathological variables were collected and analyzed. Subgroup analyses were further performed in patients with tumors larger than 10 cm. Univariate and multivariate logistic regression analyses were conducted to identify independent risk factors for peri-operative blood transfusion, complications, and postoperative hospital stay.
Results:
Baseline characteristics were comparable except for tumor size, which was significantly larger in the open surgery group (13.36 ± 5.49 vs. 9.43 ± 2.31 cm, P = 0.006). MIS was associated with lower estimated blood loss (90.00 vs. 350.00 mL, P < 0.001), and shorter postoperative hospital stays (9.00 ± 3.83 vs.5.23 ± 1.31 days, P < 0.001). Similar results were observed in the subgroup of patients with tumors larger than 10 cm. Adjacent organ resection was more frequent in the open group (65.00% vs. 34.60%, P = 0.041). Overall complication rate was similar (65.00% vs. 46.20%, P = 0.203), but all three major complications (Clavien-Dindo grade ≥ III) occurred in the open group. On multivariate analysis, surgical method (open or MIS) was identified as an independent predictor of postoperative hospital stay (OR 0.074, P < 0.001), while adjacent organ resection was the only independent risk factor for peri-operative complications (OR 8.481, P = 0.005).
Conclusion:
Both MIS and open surgery are safe and effective selection for patients with perirenal tumors larger than 7 cm. MIS may offer faster recovery and less blood loss, while open surgery remains necessary for large tumors. Multicenter prospective studies with extended follow-up are needed to validate these findings.
