Comparison of perioperative, renal and oncologic outcomes in robotic‐assisted versus open partial nephrectomy

• Published in: ANZ journal of surgery Vol. 88; no. 3; pp. E194 - E199
• Main Authors: Tan, Jo‐Lynn, Frydenberg, Mark, Grummet, Jeremy, Hanegbi, Uri, Snow, Ross, Mann, Sarah, Begashaw, Kirobel, Moon, Daniel
• Format: Journal Article
• Language: English
• Published: Melbourne John Wiley & Sons Australia, Ltd 01.03.2018; Blackwell Publishing Ltd
• Subjects: Aged; Australia; Blood Loss, Surgical; Carcinoma - pathology; Carcinoma - surgery; Complications; Creatinine; Data processing; Demographics; Demography; Epidermal growth factor receptors; Female; Glomerular filtration rate; Humans; kidney; Kidney Neoplasms - pathology; Kidney Neoplasms - surgery; Length of Stay; Male; Malignancy; Margins of Excision; Middle Aged; Neoplasm Staging; Nephrectomy; Nephrectomy - adverse effects; Operative Time; partial nephrectomy; Polarity; Postoperative Complications - epidemiology; Renal function; renal tumour; Retrospective Studies; Robotic surgery; Robotic Surgical Procedures - adverse effects; Robotics; Surgery; Treatment Outcome; Tumors; Urology; Warm Ischemia; kidney; complications; renal tumour; partial nephrectomy; robotic surgery
• ISSN: 1445-1433; 1445-2197
• DOI: 10.1111/ans.14154

Background To compare perioperative, renal and oncological outcomes after robotic‐assisted partial nephrectomy (RAPN) versus open partial nephrectomy (OPN) for the treatment of renal tumours. Methods All partial nephrectomies performed at a Metropolitan Urology Centre between 2010 and 2016 were analysed. Baseline data was collected for patient demographics, tumour characteristics (tumour size, laterality and polarity, RENAL scores), and perioperative variables (e.g. warm ischaemic time, operation time, estimated blood loss (EBL), length of stay). Tumour characteristics included malignancy, clinical stage, Fuhrman nuclear grade and surgical margin status. Day‐1 post‐operative serum creatinine, estimated glomerular filtration rate (eGFR) and 6‐month eGFR stage were used for assessing renal function. Results Two hundred patients underwent partial nephrectomy between 2010 and 2016 (n = 200; 55 OPN versus 145 RAPN). Baseline data was similar between groups, except for lower age (P = 0.0001) and higher RENAL scores (P = 0.001) in the RAPN group. RAPN demonstrated significantly lower complication rates (P = 0.015), lesser EBL (P = <0.0001), shorter hospital stays (P = <0.001) and reduced positive tumour resection margins (P = 0.039). There was no significant difference in mean operation time between RAPN and OPN (137.2 (±48.0) OPN versus 146.07 (±35.91) RAPN; P = 0.16). No statistical difference was shown for post‐operative eGFR stage between groups at Day‐1 and 6‐month post‐surgery (P = 0.15 and P = 0.861, respectively). Conclusion We present the largest reported Australian series on partial nephrectomy, confirming that a robotic‐assisted approach is equivalent to OPN, with reduced complications, EBL, length of hospital stays and fewer positive margins, even when resecting more complex tumours.