Robotic versus laparoscopic radical nephrectomy: a large multi-institutional analysis (ROSULA Collaborative Group).

To compare the outcomes of robotic radical nephrectomy (RRN) to those of laparoscopic radical nephrectomy (LRN) for large renal masses.

This was a retrospective analysis of RRN and LRN cases performed for large (≥ cT2) renal masses from 2004 to 2017 and collected in the multi-institutional international database (ROSULA: RObotic SUrgery for LArge renal masses). Peri-operative, functional, and oncologic outcomes were compared between each approach. Descriptive analyses were performed and presented as medians with interquartile ranges. Inverse probability of treatment weighting-adjusted multivariable analyses were used to identify predictors of peri-operative complications. Kaplan-Meier analysis and Cox regression models were used to assess survival outcomes.

A total of 941 patients (RRN = 404, LRN = 537) were identified. There was no difference in terms of gender, age, and clinical tumor size. Over the study period, RRN had an annual increase of 11.75% (95% CI [7.34, 17.01] p < 0.001) and LRN had an annual decline of 5.39% (95% CI [-6.94, -3.86] p < 0.001). Patients undergoing RRN had higher BMI (27.6 [IQR 24.8-31.1] vs. 26.5 [24.1-30.0] kg/m2, p < 0.01). Operative duration was longer for RRN (185.0 [150.0-237.2] vs. 126 [90.8-180.0] min, p < 0.001). Length of stay was shorter for RRN (3.0 [2.0-4.0] vs. 5.0 [4.0-7.0] days, p < 0.001). RRN cases presented more advanced disease (higher pathologic staging [pT3-4 52.5 vs. 24.2%, p < 0.001], histologic grade [high grade 49.3 vs. 30.4%, p < 0.001], and rate of nodal disease [pN1 5.4 vs. 1.9%, p < 0.01]). Surgical approach did not represent an independent risk factor for peri-operative complications (OR 1.81 95% CI [0.97-3.39], adjusted p = 0.2). The main study limitation is the retrospective design.

This study represents the largest known multi-center comparison between RRN and LRN. The two procedures seem to offer similar peri-operative outcomes. Notably, RRN has been increasingly utilized, especially in the setting of more advanced and surgically challenging disease without increasing the risk of peri-operative complications.

World journal of urology. 2019 Feb 07 [Epub ahead of print]

Uzoma A Anele, Michele Marchioni, Bo Yang, Giuseppe Simone, Robert G Uzzo, Clayton Lau, Maria C Mir, Umberto Capitanio, James Porter, Ken Jacobsohn, Nicolo de Luyk, Andrea Mari, Kidon Chang, Cristian Fiori, Jay Sulek, Alexandre Mottrie, Wesley White, Sisto Perdona, Giuseppe Quarto, Ahmet Bindayi, Akbar Ashrafi, Luigi Schips, Francesco Berardinelli, Chao Zhang, Michele Gallucci, Miguel Ramirez-Backhaus, Alessandro Larcher, Patrick Kilday, Michael Liao, Peter Langenstroer, Prokar Dasgupta, Ben Challacombe, Alexander Kutikov, Andrea Minervini, Koon Ho Rha, Chandru P Sundaram, Lance J Hampton, Francesco Porpiglia, Monish Aron, Ithaar Derweesh, Riccardo Autorino

Division of Urology, Virginia Commonwealth University School of Medicine, Richmond, VA, USA., Department of Urology, SS Annunziata Hospital, "G.D'Annunzio" University of Chieti, Chieti, Italy., Department of Urology, Changhai Hospital, Shanghai, China., Department of Urology, IRCCS - "Regina Elena" National Cancer Institute, Rome, Italy., Division of Urology, Fox Chase Cancer Center, Philadelphia, PA, USA., Division of Urology, City of Hope Medical Center, Duarte, CA, USA., Department of Urology, Fundacion Instituto Valenciano Oncologia, Valencia, Spain., Unit of Urology, Division of Oncology, Urological Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy., Swedish Urology Group, Seattle, WA, USA., Department of Urology, Medical College Wisconsin, Milwaukee, WI, USA., Urology Centre, Guy's and St Thomas's NHS Foundation Trust, London, UK., Department of Urology, University of Florence, Careggi Hospital, Florence, Italy., Department of Urology, Yonsei Wonju, University College of Medicine, Wonju, Korea., Department of Urology, University of Turin-San Luigi Gonzaga Hospital, Turin, Italy., Department of Urology, Indiana University School of Medicine, Indianapolis, IN, USA., ORSI Academy, Melle, Belgium., Department of Urology, University of Tennessee Medical Center, Knoxville, TN, USA., SC Urologia, Istituto Nazionale Tumori IRCCS, Fondazione Pascale, Napoli, Italy., Department of Urology, UC San Diego Health System, La Jolla, CA, USA., Institute of Urology, University of Southern California, Los Angeles, CA, USA., Division of Urology, Virginia Commonwealth University School of Medicine, Richmond, VA, USA. .