Introduction and Objective Robotic-assisted radical nephrectomy (RRN) is increasingly utilized as an alternative to laparoscopic radical nephrectomy (LRN) but there are concerns over costs and objective benefit. In the setting of very large renal masses (>10 cm), comparison between techniques is limited and it is unclear whether a robotic approach confers any perioperative benefit over LRN or open radical nephrectomy (ORN). In this study, perioperative outcomes of RRN, LRN, and ORN for very large renal masses are compared. Methods Using the National Cancer Database, patients were identified who underwent radical nephrectomy for kidney tumors >10 cm diagnosed from 2010-2015. Patients were analyzed according to surgical approach. Perioperative outcomes, including conversion to open, length of stay, readmission rates, positive surgical margins, and 30 and 90-day mortality were compared among cohorts. Results A total of 9288 patients met inclusion criteria (RRN = 842, LRN = 2326, ORN = 6120). Compared to ORN, recipients of RRN or LRN had similar rates of 30-day readmission and 30- and 90-day mortality. Length of hospital stay was significantly shorter in RRN (-1.73 days ±0.19; p<0.0001) and LRN (-1.40 days ±0.12; p<0.0001) compared to ORN. LRN had a higher rate of conversion to open compared to RRN (OR 1.48; 95% CI 1.10-1.98; p=0.0087). Conversion to open from RRN or LRN added 1.3 additional days of inpatient stay. Over the study period, RRN use increased from 4.1% to 14.8%, LRN from 20.9% to 25.6%, while ORN use decreased from 75% to 59.6%. Conclusions Minimally invasive approaches are increasingly utilized in very large renal masses. RRN has lower rates of conversion to open but produces comparable perioperative outcomes to LRN. Minimally invasive approaches have a shorter length of inpatient stay but otherwise report similar surgical margin status, readmission rates, and mortality rates compared to open radical nephrectomy.
Journal of endourology. 2021 Jun 19 [Epub ahead of print]
Logan Wilson Grimaud, Felix V Chen, Jenny Chang, Argyrios Ziogas, John Sfakianos, Ketan K Badani, Edward Uchio, Hoda Anton-Culver, Greg Gin
University of California Irvine, 8788, Urology, 101 The City Drive South, Orange, California, United States, 92868; ., University of California Irvine, 8788, Urology, Orange, California, United States; ., University of California Irvine, 8788, Medicine, 301 Med Surge II, Irvine, California, United States, 92697; ., University of California Irvine School of Medicine, 12219, Medicine, Irvine, California, United States; ., Icahn School of Medicine at Mount Sinai, 5925, Urology, New York, New York, United States; ., Icahn School of Medicine at Mount Sinai, Urology, New York, New York, United States; ., UCI Health, 14447, Urology, 333 City Blvd. West, Suite 2100, Orange, California, United States, 92868-3201; ., University of California Irvine School of Medicine, 12219, Medicine , Irvine, California, United States; ., UCI, 8788, 333 City Blvd. West, Suite 2100, Orange, California, United States, 92868.