Comparison of Transperitoneal and Retroperitoneal Robotic Partial Nephrectomy for Patients With Complete Upper Pole Renal Tumors

Abstract

ObjectivesWe compared the outcomes of transperitoneal robotic partial nephrectomy (TRPN) and retroperitoneal robotic partial nephrectomy (RRPN) for complete upper pole renal masses (1 point for the “L” component of the RENAL scoring system).Material and MethodsWe retrospectively reviewed patients who underwent either TRPN or RRPN from 2013 to 2016. Baseline demographics and perioperative, functional, and oncological results were compared. Multivariable analysis was performed to identify factors related to pentafecta achievement (ischemia time ≤25 min, negative margin, perioperative complication free, glomerular filtration rate (eGFR) preservation >90%, and no chronic kidney disease upstaging).ResultsNo significant differences between TRPN vs. RRPN were noted for operating time (110 vs. 114 min, p = 0.870), renal artery clamping time (19 vs. 18 min, p = 0.248), rate of positive margins (0.0% vs. 3.3%, p = 0.502), postoperative complication rates (25.0% vs. 13.3%, p = 0.140). TRPN was associated with a more estimated blood loss (50 vs. 40 ml, p = 0.004). There were no significant differences in pathologic variables, rate of eGFR decline for postoperative 12-month (9.0% vs. 7.1%, p = 0.449) functional follow-up. Multivariate analysis identified that only RENAL score (odd ratio: 0.641; 95% confidence interval: 0.455–0.904; p = 0.011) was independently associated with the pentafecta achievement.ConclusionsFor completely upper pole renal masses, both TRPN and RRPN have good and comparable results. Both surgical approaches remain viable options in the treatment of these cases.

Comparison of Transperitoneal and Retroperitoneal Robotic Partial Nephrectomy for Patients with Completely Lower Pole Renal Tumors

“…Combined with the data mentioned above, the patient’s tumor size, RENAL score, preoperative renal function and ischemia time had no significant difference, so it is logical and credible that there was an absence of difference in postoperative functional and oncological outcomes. In addition, our research reported renal function and tumor termination similarly to the previous literature [ 13 , 16 ].…”

“…Despite these limitations, our comparative study remains the initial report of TRPN and RRPN in completely lower pole renal masses. The current study should be seen as a complement to our previous studies on completely endophytic and completely upper polar renal tumors [ 13 , 16 ]. All three studies together confirmed that RRPN and TRPN have similar and reliable benefits for renal tumors in different locations.…”

“…That is to say, comparative studies of different preoperative features of renal tumors were necessary to provide evidence of approach selection. In two previous studies, we have reported comparative results of RRPN and TRPN in complete endophytic and complete upper polar renal tumors, demonstrating the excellent and similar clinical outcomes and safety [ 13 , 16 ].…”

“…Trocar placement of TRPN and RRPN were performed as previously described ( Supplementary Figures S2B and S3B ) [ 13 ]. For TRPN, place the patient in a transverse cubic position of 60°–70° and support the lateral extension with a gel pad ( Supplementary Figure S2A ).…”

Robotic transperitoneal versus retroperitoneal approach for anterior renal mass nephron-sparing surgery

“…Takagi et al compared TP and RP approaches when treating lateral tumors while Gu and colleagues investigated the same in the upper pole with findings in both studies showing lower estimated blood loss (EBL) and a shorter length of stay (LOS) in RP approach patients and similar complication rates between RP and TP approaches. 10 , 11 …”