Robot-assisted partial nephrectomy (RAPN) represents the preferred minimally-invasive approach for localized renal tumors. Increasing attention has focused on optimizing parenchymal preservation, with enucleation proposed as a potentially advantageous strategy. This study aimed to compare perioperative and functional outcomes of enucleation versus enucleoresection in a large, contemporary multicenter RAPN cohort.
Data were extracted from the multicentric and multicontinental European Association of Urology Young Academic Urologists (EAU-YAU) Renal Cancer Working Party database. Patients undergoing RAPN between 2015 and 2024 with clearly documented resection technique (enucleation vs enucleoresection) were included. The resection technique was chosen based on the surgeon's preference. Perioperative, pathological, and renal functional outcomes were evaluated. Acute kidney injury (AKI - defined according to the AKIN classification) and chronic kidney disease (CKD) worsening served as primary endpoints. Logistic regression and Cox proportional hazards models were used to assess the association between surgical technique and the risk of AKI and CKD progression; Kaplan-Meier curves were used to depict time-to-event and functional outcomes, while longitudinal eGFR analyses were performed to evaluate renal function trends over time.
Among 1260 patients, 527 (42%) underwent enucleation and 733 (58%) enucleoresection. Adoption of both techniques remained stable over time. Baseline characteristics were comparable. Enucleoresection was associated with longer ischemia time, higher intraoperative complication rates, and a lower positive surgical margin rate (5.2% vs 8.3%, p = 0.003). Postoperative AKI occurred more frequently after enucleoresection (18% vs 3%, p < 0.001), although eGFR recovery was similar at a median follow-up of 12 vs 25 months. In the overall cohort and among patients with baseline CKD stages 1-2, enucleation was associated with a lower risk of CKD progression (p < 0.001).
Enucleation during RAPN offers a parenchyma-sparing approach with potential functional advantages, particularly in patients with preserved baseline renal function. This benefit must be balanced against a slightly higher risk of positive margins, reinforcing the necessity of thoughtful case selection and standardized surgical technique.
Surgical oncology. 2026 Mar 23 [Epub ahead of print]
Riccardo Bertolo, Carlotta Palumbo, Giuseppe Rosiello, Federico Belladelli, Selçuk Erdem, Zine-Eddine Khene, Michele Marchioni, Zhenjie Wu, Riccardo Campi, Daniele Amparore
University of Verona, Department of Urology, Azienda Ospedaliera Universitaria Integrata, Verona, Italy. Electronic address: ., Division of Urology, Department of Translational Medicine, University of Eastern Piedmont, Maggiore della Carità Hospital, Novara, Italy., Department of Urology, Division of Experimental Oncology/Unit of Urology, IRCCS Ospedale San Raffaele, Italy., Division of Urologic Oncology, Department of Urology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Türkiye., Department of Urology, University of Rennes, Rennes, France., Department of Urology, Leonardo Hospital Group, Saint Camillus International University of Health Sciences - Unicamillus, Abano Terme, Italy., Department of Urology, Changhai Hospital, Naval Medical University, Shanghai, China., Unit of Urological Robotic Surgery and Renal Transplantation, Department of Experimental and Clinical Medicine Careggi Hospital, University of Florence, Florence, Italy., Department of Oncology, University of Turin, Orbassano, Turin, Italy; Division of Urology, Department of Surgery, Candiolo Cancer Institute, Fpo-irCCS, Candiolo, Turin, Italy.