Robotic-assisted partial nephrectomy provides better operative outcomes as compared to the laparoscopic and open approaches: results from a prospective cohort study

Abstract

The objective of this is to compare the surgical outcomes of partial nephrectomy (PN), performed via three different approaches: robot-assisted (RAPN), laparoscopic (LPN), and open (OPN), in a single non-academic regional center. The data of patients undergoing PN at our Department from 2005 to 2016 were prospectively collected. A logistic regression model adjusted for preoperative variables (age, tumor size, creatinine and hemoglobin, ASA and Padua scores) was performed to evaluate whether transfusion, conversion, and postoperative complication rate were influenced by the surgical approach. Overall 270 patients underwent PN: analysis included 253 cases (RAPN = 110, LPN = 70, OPN = 73). Preoperative variables did not differ significantly among the three groups. Shorter operative (130 vs 180 and 200') and ischaemia (12 vs 23 and 22') times and longer hospital stay (8 vs 7 and 6 days) were found in the OPN group as compared to LPN and RAPN, respectively. The RAPN group included a higher rate of pT1b (31.8 vs 14.2 and 15%) and malignant histotype (90 vs 82.9 and 68.5%) as compared to LPN and OPN, respectively. Clavien Grade III-IV complications were lower in the RAPN (7.2%) as compared to OPN (12.3%) and LPN (17.1%) groups. Multivariate analysis showed a lower risk for conversion, transfusion and overall complications in the RAPN group versus LPN and OPN. The surgical approach affects the perioperative outcomes in a regional setting. The advantages of RAPN over OPN (lower risk of conversion, transfusion, and overall complications) are extended over LPN as well, although OPN offered faster operative and ischemia times at the expense of greater blood loss and hospital stay.

Robot‐assisted partial nephrectomy is associated with early recovery of renal function: Comparison of open, laparoscopic, and robot‐assisted partial nephrectomy using DTPA renal scintigraphy

“…Robotic surgery may also decrease blood loss during surgery. In our study, RAPN was associated with the lowest EBL, which agrees with previous research . Blood loss could be associated with apoptosis caused by hypoxic damage and mitochondrial dysfunction caused by reactive oxygen species; robotic surgery minimizes both of these factors and also increases intraabdominal pressure, which could help to reduce bleeding.…”

“…A prospective randomized study would provide more robust evidence, but a randomized study to answer our study questions would be practically and ethically difficult to achieve. Nonetheless, our findings provide important evidence, and our sample size was larger than previous related studies . Second, as the postoperative interval increased, there were more follow‐up losses of patients who underwent DTPA scanning.…”

“…There are many studies comparing two approaches to partial nephrectomy, and most studies have shown similar oncologic and functional outcomes . However, there is a dearth of research comparing three different approaches to partial nephrectomy, and the few existing published studies have few cases and short follow‐up . Recently, one multicenter study comparing three operation types reported similar oncologic outcomes but showed that RAPN can reduce chronic kidney disease upstaging (using estimated GFR) more than OPN and LPN .…”

“…7 However, there is a dearth of research comparing three different approaches to partial nephrectomy, and the few existing published studies have few cases and short followup. 8,9 Recently, one multicenter study comparing three operation types reported similar oncologic outcomes but showed that RAPN can reduce chronic kidney disease upstaging (using estimated GFR) more than OPN and LPN. 10 However, as far as we know, there is no published study comparing three operation types with separated renal function using diethylene triamine penta-acetic acid (DTPA) renal scanning.…”

Open versus robotic partial nephrectomy: Systematic review and meta‐analysis of contemporary studies

“…Thirty‐four eligible studies included 60 808 patients who underwent PN, of whom 19 638 underwent RaPN with mean age 58.9 years and 41 170 underwent OPN with mean age 58.5 years. Table presents the baseline patient demographics of all enrolled studies.…”