To compare operative, functional, and oncological outcomes between laparoscopic partial nephrectomy (LPN) and robot-assisted partial nephrectomy (RAPN) for intermediate/high-complexity (R.E.N.A.L. nephrometry score ≥ 7) endophytic renal tumors (ERTs) by propensity score matching (PSM) analysis.
We retrospectively analyzed data from 191 patients who underwent LPN (n = 120) or RAPN (n = 71) between June 2011 and June 2021. PSM was performed in a 1:1 ratio to balance preoperative characteristics, resulting in 70 matched pairs. Operative, functional, and oncological outcomes were then compared. Univariate and multivariate logistic regression identified factors associated with a trifecta and pentafecta failure, and Kaplan-Meier survival analysis compared survival outcomes.
RAPN was associated with shorter median warm ischemia time (23.5 vs. 27.5 min, P < 0.001), higher trifecta achievement (60% vs. 30%, P < 0.001), and less eGFR decline at 48 h postoperatively (14.9 vs. 21.0 mL/min/1.73 m², P = 0.011) compared to LPN. There were no significant differences in other perioperative or pathology outcomes, and long-term renal function and survival outcomes were similar between the two groups. High complexity (R.E.N.A.L. nephrometry score range of 10 to 12) was an independent risk factor for trifecta (OR = 2.65; 95% CI, 1.16-6.07, P = 0.021) and pentafecta (OR = 2.65; 95% CI, 1.06-6.67, p = 0.038) failures. LPN was also an independent risk factor for trifecta failure (OR = 4.53; 95% CI, 2.11-9.76, P < 0.001) but not for pentafecta failure.
RAPN demonstrates better efficacy than LPN in protecting short-term renal function and achieving trifecta, while maintaining comparable long-term outcomes in intermediate/high-complexity ERTs. The high complexity was a significant independent risk factor for failing to achieve both trifecta and pentafecta.
BMC cancer. 2025 Oct 01*** epublish ***
Luyao Chen, Sheng Li, Fuchun Zheng, Zhongqi Li, Ruize Yuan, Ming Jiang, Yue Gao, Yanping Song, Bin Fu, Lizhi Zhou, Situ Xiong, Jiangxi Li, Jin Zeng
Jiangxi Provincial Key Laboratory of Urinary System Diseases, Department of Urology, The First Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, Jiangxi, China., Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN, USA., Department of Quality Control, The First Affiliated Hospital of Nanchang University, Nanchang, China., Jiangxi Provincial Key Laboratory of Urinary System Diseases, Department of Urology, The First Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, Jiangxi, China. ., Technology Department, The First Affiliated Hospital of Nanchang University, Nanchang, China. ., Jiangxi Provincial Key Laboratory of Urinary System Diseases, Department of Urology, The First Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, Jiangxi, China. .