Laparoscopic Versus Robot-assisted Partial Nephrectomy for Renal Tumors Larger than 4 cm: A Propensity-Score Based Analysis

To compare perioperative, functional, and oncological outcomes between laparoscopic partial nephrectomy (LPN) and robot-assisted partial nephrectomy (RAPN) for renal tumors >4 cm.

We retrospectively reviewed patients who underwent either LPN or RAPN between 2008 and 2015. To adjust for potential baseline confounders, propensity-score matching (1:1) was performed. Perioperative data, and functional and oncological outcomes were reviewed. Disease-free, cancer specific and overall survival were analyzed using Kaplan-Meier survival curves with the log-rank tests.

A total of 197 patients underwent LPN and 96 underwent RAPN during the study period. After matching, there was no significant difference between the two groups for baseline characteristics. Within the matched cohort, the LPN group was associated with significantly higher estimated blood loss (150 vs 100 ml; p < 0.001), longer renal artery clamp time (25 vs 20 min; p < 0.001), longer postoperative hospital stay (7 vs 5 day; p < 0.001) and lower rate of MIC achievement (30.2 vs 46.9%; p = 0.018). The postoperative percentage of eGFR decline was higher in the LPN group (11.3 vs 5.5%; p = 0.018). Outcomes of complication and surgical conversion were similar between LPN and RAPN. There was no significant difference in oncologic outcomes between the two groups.

For patients with renal tumors larger than 4cm, RAPN is more favorable than LPN in terms of perioperative outcomes (i.e. estimated blood loss, renal artery clamp time and postoperative hospital stay), and early renal functional preservation. This article is protected by copyright. All rights reserved.

BJU international. 2018 May 11 [Epub ahead of print]

Liangyou Gu, Hongzhao Li, Baojun Wang, Yongpeng Xie, Xintao Li, Yu Gao, Xiangjun Lyu, Qingbo Huang, Yang Fan, Yuanxin Yao, Yunpeng Wang, Xin Ma, Xu Zhang

Department of Urology/State Key Laboratory of Kidney Diseases, Chinese PLA General Hospital/PLA Medical School, Beijing, China.