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The oncological impact of positive surgical margins (PSM) after robot-assisted partial nephrectomy (RAPN) is still under debate. We compared PSM and Negative Surgical Margins (NSM) in terms of recurrence-free survival (RFS), metastasis-free survival (MFS) and overall survival (OS) after RAPN, and we identified predictive factors of PSM. Multi-institutional study using the UroCCR database, which prospectively included 2166 RAPN between April 2010 and February 2021 (CNIL DR 2013-206; NCT03293563). Two groups were retrospectively compared: PSM versus NSM. Prognostic factors were assessed using Kaplan–Meyer curves with log-Rank test, cox hazard proportional risk model and logistic regression after univariate comparison. 136 patients had PSM (6.3%) and 2030 (93.7%) had NSM. During a median follow-up of 19 (9–36) months after RAPN, 160 (7.4%) recurrences were reported. Kaplan–Meier curves and analysis suggested that RFS, MFS and OS were not affected by a PSM (p = 0.68; 0.71; 0.88, respectively). In multivariate analysis predictors of PSM were a lower RENAL score (p = 0.001), longer warm ischemia time (WIT) (p = 0.003) and Chromophobe Renal Cell Carcinoma (chrRCC) (p = 0.043). This study found no impact of PSM on RFS, MFS or OS, and predictors of PSM were the RENAL score, WIT and chrRCC.

perioperative outcomes were compared between multiport (MP) and single port (SP) using c 2 , Fisher's exact, and Mann-Whitney U test in the overall cohort and in a 1:1 propensity score-matched cohort, adjusting for baseline characteristics and surgeons.RESULTS: A total of 3,008 patients were included in this study: multiport (n[2,860, 95.08%) and single port (n[148, 4.92%). After propensity matching, 121 (50.00%) SP patients were matched with 121(50.00%) MP patients. Matched SP patients (59 years [IQR: 51, 68]) had similar median age when compared to the MP patients (60 years [IQR: 49, 69]). Compared to matched MP group, the matched SP had a longer median ischemia (16.0 mins [IQR: 11.5, 25.0] vs 13.2 mins [IQR: 10.0, 17.0]; p[0.0001). Although the EBL (50ml [IQR: 25, 100] vs 50ml [IQR: 50, 100]; p[0.002) and LOS (1 day [IQR: 1, 1] vs 1 day [IQR: 1, 2]; p[0.001) were the same, the mean rank sum was significantly lower in the single port groups. Operative time (138 mins [IQR: 113, 170] vs 128 mins [IQR: 90, 174]; p[0.140), positive margin rate (3.31% vs 7.44; p[0.254) and any complication rate (4.96% vs 9.09%; p[ 0.209) were similar between the two groups.CONCLUSIONS: SP partial nephrectomy presented longer ischemia time, lower EBL, lower LOS, similar operative time, similar positive margin and complication rates when compared to multi-port. This early data is encouraging. However, the role of SP requires further study and should evaluate safety and long-term data when compared to the standard multi-port technique.

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