Aim of this study was to evaluate and compare perioperative outcomes of transperitoneal (TP) and retroperitoneal (TR) approaches in a multi-institutional cohort of minimally invasive partial nephrectomy (MI-PN).
All consecutive patients undergone MI-PN for clinical T1 renal tumors at 26 Italian centers (RECORd2 project) between 01/2013 and 12/2016 were evaluated, collecting the pre-, intra-, and postoperative data. The patients were then stratified according to the surgical approach, TP or RP. A 1:1 propensity score (PS) matching was performed to obtain homogeneous cohorts, considering the age, gender, baseline eGFR, surgical indication, clinical diameter, and PADUA score.
1669 patients treated with MI-PN were included in the study, 1256 and 413 undergoing TP and RP, respectively. After 1:1 PS matching according to the surgical access, 413 patients were selected from TP group to be compared with the 413 RP patients. Concerning intraoperative variables, no differences were found between the two groups in terms of surgical approach (lap/robot), extirpative technique (enucleation vs standard PN), hilar clamping, and ischemia time. Conversely, the TP group recorded a shorter median operative time in comparison with the RP group (115 vs 150 min), with a higher occurrence of intraoperative overall, 21 (5.0%) vs 9 (2.1%); p = 0.03, and surgical complications, 18 (4.3%) vs 7 (1.7%); p = 0.04. Concerning postoperative variables, the two groups resulted comparable in terms of complications, positive surgical margins and renal function, even if the RP group recorded a shorter median drainage duration and hospital length of stay (3 vs 2 for both variables), p < 0.0001.
The results of this study suggest that both TP and RP are feasible approaches when performing MI-PN, irrespectively from tumor location or surgical complexity. Notwithstanding longer operative times, RP seems to have a slighter intraoperative complication rate with earlier postoperative recovery when compared with TP.
Surgical endoscopy. 2020 Aug 27 [Epub ahead of print]
Francesco Porpiglia, Andrea Mari, Daniele Amparore, Cristian Fiori, Alessandro Antonelli, Walter Artibani, Pierluigi Bove, Eugenio Brunocilla, Umberto Capitanio, Luigi Da Pozzo, Fabrizio Di Maida, Paolo Gontero, Nicola Longo, Giancarlo Marra, Bernardo Rocco, Riccardo Schiavina, Claudio Simeone, Salvatore Siracusano, Riccardo Tellini, Carlo Terrone, Donata Villari, Vincenzo Ficarra, Marco Carini, Andrea Minervini, RECORD 2 Project
Division of Urology, Department of Oncology- School of Medicine, University of Turin, San Luigi Hospital, Orbassano, Turin, Italy., Department of Urology, Unit of Oncologic Minimally-Invasive Urology and Andrology, Careggi Hospital, University of Florence, Florence, Italy., Department of Urology, Spedali Civili Hospital, University of Brescia, Brescia, Italy., Department of Urology, Azienda Ospedaliera Universitaria Integrata (A.O.U.I.), Verona, Italy., Department of Urology, University Hospital of Tor Vergata, Rome, Italy., Department of Urology, University of Bologna, Bologna, Italy., Unit of Urology, Division of Experimental Oncology, URI-Urological Research Institute, Vita-Salute San Raffaele University, IRCCS San Raffaele Scientific Institute, Milan, Italy., Department of Urology, Papa Giovanni XXIII Hospital, Bergamo, Italy., Division of Urology, Department of Surgical Sciences, San Giovanni Battista Hospital, University of Studies of Torino, Turin, Italy., Department of Urology, University Federico II of Naples, Naples, Italy., Department of Urology, Fondazione IRCCS Ca' Granda' Ospedale Maggiore Policlinico' Policlinico' University of Milan, Milan, Italy., Department of Urology, University of Genova, Genova, Italy., Department of Urology, Unit of Urological Minimally Invasive Robotic Surgery and Renal Transplantation, Careggi Hospital, University of Florence, Florence, Italy., Department of Human and Paediatric Pathology, Gaetano Barresi, Urologic Section, University of Messina, Messina, Italy., Division of Urology, Department of Oncology- School of Medicine, University of Turin, San Luigi Hospital, Orbassano, Turin, Italy. .