AUA 2017: A Multi-Institutional Propensity Score Matched Comparison of Transperitoneal vs. Retroperitoneal Robotic Partial Nephrectomy for Posterior Clinical T1 Renal Masses

Boston, MA (UroToday.com) Several single institutional series have reported improved surgical outcomes in patients with posterior renal masses managed with a retroperitoneal robotic partial nephrectomy. The reason for this improvement is the decrease need for renal mobilization, easier access to the renal artery, improved tumor visualization in patient with hilar posterior masses, and avoidance of the intraperitoneal cavity in patients with hostile abdomens. Surgeons not in favor of the approach argue decrease working space, challenging access and inability to control the entire hilum in cases of severe hemorrhage. The study aims to elucidate any benefit associated with a retroperitoneal (RT) compared to a transperitoneal (TP) robotic assisted approach for the management of small posterior renal masses.

Patient and surgical information was extracted from a prospectively maintained multi-institutional data base which includes 1684 patients who underwent robotic assisted partial nephrectomy for a solitary cT1a renal mass. Patient with a tumor located in the anterior or lateral aspect of the kidney were excluded from the analysis. 519 patients were included in the analysis, 367 (69%) undergoing a TP (31%) and 162 a RP approach. The patients were match using propensity score matching in regards to patients and tumor characteristics. Postoperative and renal function outcomes were compared between the 2 groups using Mann-Whitney U test and Chi-square analyses.

On evaluation of operative factors there was no significant differences in warm ischemia time (WIT), estimated blood loss (EBL), margin rate and post-operative complications. The RT approach was associated with a shorter operative times (157 min vs 185 min, p < 0.01). There was no difference in GFR deterioration between the two techniques at median follow-up.

In conclusion, both approaches have been shown to be safe and effective for the management of posterior small renal masses. The RT approach is associated with shorter operative times likely related to the lack of renal mobilization and easier access to the hilum. The study has a number of limitation one of which is the retrospective nature of the study and the fact that most of the RP cases were done by a single surgeon. Learning curves should be included in all reports discussing technique comparisons as this is the most important information for the practicing urologist who is considering adopting a new technique.

Presented By: David Paulucci, MD, Mount Sinai School of Medicine, NY

Written By: Andres F. Correa, MD, Society of Urologic Oncology Fellow, Fox Chase Cancer Center, Philadelphia, PA

at the 2017 AUA Annual Meeting - May 12 - 16, 2017 – Boston, Massachusetts, USA

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