Robot‐assisted versus laparoscopic partial nephrectomy for anatomically complex T1b renal tumors with a RENAL nephrometry score ≥7: A propensity score‐based analysis

Abstract

Objectives:To present the perioperative, functional, and oncological outcomes of robot-assisted partial nephrectomy (RPN) compared with laparoscopic partial nephrectomy (LPN) for anatomically complex T1b renal tumors with RENAL nephrometry scores ≥7. Patients and methods: One hundred and seventy patients, during the study period, were retrospectively reviewed in our analysis according to inclusion criteria.Propensity score matching (PSM) (1:1) method was applied to impose restrictions on the potential baseline confounders. The comparisons of perioperative and functional outcomes between the RPN and LPN groups were conducted and analyzed after PSM, Kaplan-Meier analyses were performed to assess the differences about oncological outcomes between the two groups before and after PSM. Results: One hundred and nine and 61 T1b renal tumors with RENAL scores ≥7 were identified in the LPN and RPN groups, respectively. All significant differences in baseline characteristics disappeared after PSM. Except for 3 patients missing an appropriate pair, all the patients in the RPN group were successfully matched to 58 patients in the LPN group in a 1:1 ratio. Within the matched cohort, the RPN group was related to a significantly shorter mean operating time (OT) (P = .040), shorter mean warm ischemia time (WIT) (P = .023), and shorter median postoperative hospital stay (P = .023). The possibilities of surgical conversion, postoperative complication, and positive surgical margin were similar in the LPN and RPN groups.And there was also no significant difference in the pathological, renal functional, and oncological outcomes between the two series. Conclusions: For patients with anatomically complex T1b renal tumors with a RENAL nephrometry score ≥7, RPN had an advantage over LPN in reducing OT, WIT, and postoperative hospital stay length without increasing the risk of | 587 DENG Et al.

Comparison Robotic versus laparoscopic partial nephrectomy for Complex Renal Tumors (with a RENAL nephrometry score≥7): a meta-analysis

“…Seven studies were involved in our study [1,7,[11][12][13][14][15]. The literature searching process is summarized in Fig.…”

“…This could reach a quick renal function recovery. Instead, deng et al performed a study by propensity score-based analysis included 116 patients indicated that the eGFR decrease in baseline was similar between the two groups [11]. It could be deduced that RPN is favorable versus LPN in preserving renal function due to decreased WIT.…”

The clinical application value of mixed‐reality‐assisted surgical navigation for laparoscopic nephrectomy

“…For a stage T1 renal tumor (RENAL nephrometry score ≥7) or renal tumor occurring in the isolated kidney, LPN could protect renal function better than LRN 14 . Due to the application of MR technology, surgeons could more comprehensively analyze renal tumor characteristics before surgery and could more accurately locate renal tumors during surgery.…”

“…The inclusion criteria were as follows: (I) all patients underwent renal contrast‐enhanced CT scanning; (II) all patients had a stage T1 renal tumor; (III) all renal tumors had a RENAL nephrometry score 14 ≥7; (IV) all operations were performed by two senior surgeons; and (V) surgical records of the presence and area of APF were available. The exclusion criteria were as follows: (I) CT contrast agent allergy; (II) severe cardiovascular and cerebrovascular diseases; (III) severe kidney dysfunction; and (IV) severe renal artery stenosis or occlusion.…”

Ретроперитонеоскопічна Резекція Нирки З Передопераційною Селективною Емболізацією Та Флуоресцентною Візуалізацією Ниркових Судин. Аналіз Післяопераційних Ускладнень

“…Сьогодні вже зрозуміло, що використання селективної емболізації гілок ниркової артерії, що живить зону ймовірної резекції на передопераційному етапі, є доцільним, при цьому не потрібна інтраопераційна дисекція судин нирки, значно зменшується можливість травми судин, рівень крововтрати, покращується візуалізація операційного поля, кордонів "здорової" паренхіми та пухлини, стає недоцільним використання гемостатичних швів із захопленням значної частини паренхіми нирки, що у подальшому має негативне значення та спричиняє розвиток зниження функції оперованої нирки та розвиток нефросклерозу [36,37]. З урахуванням отриманих багатьма дослідженнями даних сьогодні алгоритм лікування хворих на рак нирки насамперед спрямований на мінімізацію обсягу вилученої частини органа і відповідно підвищення "функціональності" виконуваного хірургічного втручання [38,39,40].…”