Robot‐assisted versus conventional laparoscopic partial nephrectomy for renal hilar tumors: Parenchymal preservation and functional recovery

• Published in: International journal of urology Vol. 29; no. 10; pp. 1188 - 1194
• Main Authors: Bao, Xingjun, Dong, Wen, Wang, Jipeng, Sun, Fengze, Yao, Huibao, Wang, Di, Zhou, Zhongbao, Wu, Jitao
• Format: Journal Article
• Language: English
• Published: Australia Wiley Subscription Services, Inc 01.10.2022
• Subjects: Clinical trials; Computed tomography; conventional laparoscopic partial nephrectomy; functional recovery; Glomerular Filtration Rate; Humans; Kidney Neoplasms - diagnostic imaging; Kidney Neoplasms - pathology; Kidney Neoplasms - surgery; Kidneys; Laparoscopy; Laparoscopy - methods; Nephrectomy; Nephrectomy - methods; parenchymal volume preserved; Patients; Preservation; Recovery of function; renal hilar tumors; Retrospective Studies; Robotics; robot‐assisted laparoscopic partial nephrectomy; Treatment Outcome; Tumors; parenchymal volume preserved; renal hilar tumors; conventional laparoscopic partial nephrectomy; functional recovery; robot-assisted laparoscopic partial nephrectomy
• ISSN: 0919-8172; 1442-2042
• DOI: 10.1111/iju.14968

Objective To determine whether robot‐assisted laparoscopic partial nephrectomy (RALPN) can benefit patients in terms of functional recovery in the treatment of renal hilar tumors compared to conventional laparoscopic partial nephrectomy (CLPN). Methods Between January 2019 and July 2021, patients with hilar tumors who underwent partial nephrectomy (PN) were acquired at our center and were classified into RALPN and CLPN groups. Ipsilateral parenchymal volume (IPV) and glomerular filtration rate (GFR) were determined independently 3–5 days before and 3 months after PN using contrast‐enhanced computed tomography and nuclear renal scans. Pearson correlation was used to determine the link between ipsilateral GFR preservation and IPV preserved. Concurrently, multivariable analysis was employed to determine characteristics associated with functional recovery. Results A total of 96 patients with hilar tumors were studied, of which 41 received RALPN and 55 received CLPN. Excisional parenchymal volume was 27 and 37 cm3 (p = 0.005) in RALPN and CLPN groups, respectively, and IPV preserved was 77% and 68% (p < 0.001). Furthermore, the ipsilateral GFR preserved was 77.7% and 75.3%, respectively (p = 0.003). On Pearson correlation, ipsilateral GFR preservation was linked with IPV preserved (r = 0.36, p < 0.001). According to a multivariate study, baseline GFR, IPV preserved, and surgical procedures (RALPN vs. CLPN) were significant factors influencing functional recovery. Conclusion Our study suggests that RALPN, rather than CLPN, can achieve better functional recovery in the treatment of hilar tumors due to its ability to win more IPV preserved. RALPN should be recommended as the first‐line treatment for hilar tumors, but randomized controlled trials are required to validate our findings.