To assess the outcomes of retroperitoneal robot-assisted partial nephrectomy (r-RAPN) in a large cohort of patients with postero-lateral renal masses comparing to those of transperitoneal RAPN (t-RAPN).
Patients with posterior (R.E.N.A.L. score grading P) or lateral (grading X) renal mass who underwent RAPN in six high-volume US and European centers were identified and stratified into two groups according to surgical approach: r-RAPN ("study group") and t-RAPN ("control group"). Baseline characteristics, intraoperative, and postoperative data were collected and compared.
Overall, 447 patients were identified for the analysis. 231 (51.7%) and 216 (48.3%) patients underwent r-RAPN and t-RAPN, respectively. Baseline characteristics were not statistically significantly different between the groups. r-RAPN group reported lower median operative time (140 vs. 170 min, p < 0.001). No difference was found in ischemia time, estimated blood loss, and intraoperative complications. Overall, 47 and 54 postoperative complications were observed in r-RAPN and t-RAPN groups, respectively (20.3 vs. 25.1%, p = 0.9). 1 and 2 patients reported major complications (Clavien-Dindo ≥ III grade) in the retroperitoneal and transperitoneal groups (0.4 vs. 0.9%, p = 0.9). There was no difference in hospital re-admission rate, median length of stay, and PSM rate. Trifecta criteria were achieved in 90.3 and 89.2% of r-RAPN and t-RAPN, respectively (p = 0.7).
r-RAPN and t-RAPN offer similar postoperative, functional, and oncological outcomes for patients with postero-lateral renal tumors. Our analysis suggests an advantage for r-RAPN in terms of shorter operative time, whereas it does not confirm a difference in terms of length of stay, as suggested by previous reports.
World journal of urology. 2021 May 29 [Epub ahead of print]
Umberto Carbonara, Daniel Eun, Ithaar Derweesh, Umberto Capitanio, Antonio Celia, Cristian Fiori, Enrico Checcucci, Daniele Amparore, Jennifer Lee, Alessandro Larcher, Devin Patel, Margaret Meagher, Fabio Crocerossa, Alessandro Veccia, Lance J Hampton, Francesco Montorsi, Francesco Porpiglia, Riccardo Autorino
Division of Urology, VCU Health, Richmond, VA, 23298-0118, USA., Department of Urology, Temple University, Philadelphia, PA, USA., Department of Urology, UCSD, San Diego, CA, USA., Unit of Urology, IRCCS Ospedale San Raffaele, Milan, Italy., Department of Urology, San Bassiano Hospital, Bassano del Grappa, Vicenza, Italy., Department of Urology, San Luigi Hospital, University of Turin, Orbassano, Italy., Division of Urology, VCU Health, Richmond, VA, 23298-0118, USA. .