Comparison of open and robotic-assisted partial nephrectomy approaches using multicentric data (UroCCR-47 study)

Abstract

We compared the outcomes of robotic-assisted partial nephrectomy (RPN) and open partial nephrectomy (OPN) using contemporary data to respond to unmet clinical needs. Data from patients included in the registry who underwent partial nephrectomy between January 01, 2014 and June 30, 2017 within 20 centres of the French Network for Research on Kidney Cancer UroCCR were collected (NCT03293563). Statistical methods included adjusted multivariable analyses. Rates of peri- and post-operative transfusion, and of surgical revision, were lower in the RPN (n = 1434) than the OPN (n = 571) group (2.9% vs. 6.0%, p = 0.0012; 3.8% vs. 11.5%, p < 0.0001; 2.4% vs. 6.7%, p < 0.0001, respectively). In multivariable analyses, RPN was independently associated with fewer early post-operative complications than OPN (overall: odds-ratio [95% confidence interval, CI] = 0.48 [0.35–0.66]; severe: 0.29 [0.16–0.54], p < 0.0001 for both) and shorter hospital stays (34% [30%; 37%], p < 0.0001). RPN was also a significantly associated with a decresedrisk of post-operative acute renal failure, and new-onset chronic kidney disease at 3 and 12 months post-surgery. There were no between-group differences in oncological outcomes. In comparison with OPN, RPN was associated with improved peri- and post-operative morbidity, better functional outcomes, and shorter hospital stays. Our results support the use of RPN, even for large and complex tumours.

Long-Term Oncological and Functional Outcomes after Laparoscopic Partial Nephrectomy with Hyperselective Embolization of Tumor Vessels in a Hybrid Operating Room

“…The rate of positive margins was 4.9%. These results are similar to the robot-assisted series of Ingels et al (4.9%), Peyronnet et al (5.2%), Pignot et al (5.7%) and Masson-Lecomte et al (8%) [ 4 , 5 , 20 , 23 ]. Despite a positive surgical margin rate comparable to that observed in the literature, the 5-year disease-free survival rate in our series (84%) appears to be in the low range compared to multicenter series, which reported that 5-year CFS estimate rates ranged from 86.4% to 98.4% [ 35 ].…”

“…The median total operative time of 168 min, including HETV, patient repositioning and LPN, appears to be shorter compared to other LPN series [ 6 , 21 ]. Our operative times seem similar to those described in the RALPN series [ 4 , 5 ]. The median laparoscopic time alone was reduced to 75 min.…”

“…The demographic data of our study were similar to those already published, in terms of age, BMI, ASA scores, tumor size, and R.E.N.A.L. complexity [ 4 , 5 , 6 , 20 ].…”

“…In contemporary RALPN series, bleeding occurred in 6% of the cases. Despite the off-clamp PN, intraoperative bleeding was 100 mL which is lower than bleeding reported in RALPN (150 to 300 mL) [ 4 , 5 , 24 ]. Hemostasis was achieved using hemostatic agents and in the majority of the cases did not require cortical suturing (96.7%), which could contribute to the preservation of healthy renal parenchyma [ 25 ].…”

“…Different approaches are described, such as open partial nephrectomy (OPN), laparoscopic partial nephrectomy (LPN) or robot-assisted laparoscopic partial nephrectomy (RALPN). Compared to both OPN and LPN, RALPN provides decreased intraoperative blood loss, shorter hospitalization time, fewer complications and shorter ischemia times [ 4 , 5 ]. As a result, RALPN has become the new gold standard technique for mini-invasive PN [ 6 ].…”