Abstract
Background
Only a few studies have compared the outcomes of robotic partial nephrectomy (RPN) and open partial nephrectomy (OPN). This study aimed to compare perioperative and oncologic outcomes of RPN and OPN.
Methods
The data of all patients who underwent partial nephrectomy from 2006 to 2014 in six academic departments of urology were retrospectively collected. Perioperative outcomes were compared between OPN and RPN patients. Cancer-specific survival (CSS) and recurrence-free survival (RFS) were estimated using the Kaplan–Meier method and compared using the log-rank test.
Results
The study included 1800 patients: 937 who underwent RPN and 863 who underwent OPN. The patients in the robotic group had smaller tumors (33.1 vs. 39.9 mm; p < 0.001) but comparable RENAL scores (6.8 vs. 6.7; p = 0.37). The complication rate was higher in the OPN group (28.6 vs. 18 %; p < 0.001). The OPN patients had greater estimated blood loss (359.5 vs. 275 ml; p < 0.001) and more frequent hemorrhagic complications (12.1 vs. 6.9 %; p < 0.001). The robotic approach was associated with a shorter warm ischemia time (WIT 15.7 vs. 18.6 min; p < 0.001) and a shorter hospital of stay (4.7 vs. 10.1 days; p < 0.001). In the propensity score-weighted analysis, the inverse probability of treatment weighting adjusted odds ratio for the risk of complication after OPN versus RPN was 2.11 (95 % confidence interval, 1.53–2.91; p < 0.001). After a median postoperative follow-up period of 13 months for OPN and 39 months for RPN (p < 0.001), CSS and RFS were similar in the two groups. In the multivariate analysis, RPN showed an impact on the occurrence of a complication but had no effect on WIT or RFS.
Conclusion
In this study, RPN was less morbid than OPN, with lower complications, less blood loss, and a shorter hospital of stay. The intermediate-term oncologic outcomes were similar in the two groups.
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References
Ljungberg B, Bensalah K, Canfield S, et al. EAU guidelines on renal cell carcinoma: 2014 update. Eur Urol. 2015;67:913–24.
Gill IS, Kavoussi LR, Lane BR, et al. Comparison of 1800 laparoscopic and open partial nephrectomies for single renal tumors. J Urol. 2007;178:41–6.
Couapel JP, Bensalah K, Bernhard JC, et al. Is there a volume-outcome relationship for partial nephrectomy? World J Urol. 2014;32:1323–9.
Gong EM, Orvieto MA, Zorn KC, et al. Comparison of laparoscopic and open partial nephrectomy in clinical T1a renal tumors. J Endourol. 2008;22:953–7.
Peyronnet B, Couapel JP, Patard JJ, et al. Relationship between surgical volume and outcomes in nephron-sparing surgery. Curr Opin Urol. 2014;24:453–8.
Porpiglia F, Bertolo R, Amparore D, et al. Margins, ischaemia, and complications rate after laparoscopic partial nephrectomy: impact of learning curve and tumour anatomical characteristics. BJU Int. 2013;112:1125–32.
Poon SA, Silberstein JL, Chen LY, et al. Trends in partial and radical nephrectomy: an analysis of case logs from certifying urologists. J Urol. 2013;190:464–9.
Patel HD, Mullins JK, Pierorazio PM, et al. Trends in renal surgery: robotic technology is associated with increased use of partial nephrectomy. J Urol. 2013;189:1229–35.
Hanzly M, Frederick A, Creighton T, et al. Learning curves for robot-assisted and laparoscopic partial nephrectomy. J Endourol. 2015;29:297–303.
Choi JE, You JH, Kim DK, et al. Comparison of perioperative outcomes between robotic and laparoscopic partial nephrectomy: a systematic review and meta-analysis. Eur Urol. 2015;67:891–901.
Liu JJ, Leppert JT, Maxwell BG, et al. Trends and perioperative outcomes for laparoscopic and robotic nephrectomy using the National Surgical Quality Improvement Program (NSQIP) database. Urol Oncol. 2014;32:473–9.
Pignot G, Méjean A, Bernhard JC, et al. The use of partial nephrectomy: results from a contemporary national prospective multicenter study. World J Urol. 2015;33:33–40.
Mottrie A, Borghesi M, Ficarra V. Is traditional laparoscopy the real competitor of robot-assisted partial nephrectomy? Eur Urol. 2012;62:1034–6.
Ficarra V, Minervini A, Antonelli A, et al. A multicentre matched-pair analysis comparing robot-assisted versus open partial nephrectomy. BJU Int. 2014;113:936–41.
Wu Z, Li M, Liu B, et al. Robotic versus open partial nephrectomy: a systematic review and meta-analysis. PLoS One. 2014;9:e94878.
Kutikov A, Uzzo RG. The RENAL nephrometry score: a comprehensive standardized system for quantitating renal tumor size, location and depth. J Urol. 2009;182:844–53.
Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg. 2004;240:205–13.
Mitropoulos D, Artibani W, Graefen M, et al. Reporting and grading of complications after urologic surgical procedures: an ad hoc EAU guidelines panel assessment and recommendations. Eur Urol. 2012;61:341–9.
Peyronnet B, Baumert H, Mathieu R, et al. Early unclamping technique during robot-assisted laparoscopic partial nephrectomy can minimise warm ischaemia without increasing morbidity. BJU Int. 2014;114:741–7.
Gettman MT, Blute ML, Chow GK, et al. Robotic-assisted laparoscopic partial nephrectomy: technique and initial clinical experience with daVinci robotic system. Urology. 2004;64:914–8.
Gill IS, Kamoi K, Aron M, et al. 800 Laparoscopic partial nephrectomies: a single-surgeon series. J Urol. 2010;183:34–41.
Hollenbeck BK, Taub DA, Miller DC, Dunn RL, Wei JT. National utilization trends of partial nephrectomy for renal cell carcinoma: a case of underutilization? Urology. 2006;67:254–9.
Porpiglia F, Volpe A, Billia M, et al Laparoscopic versus open partial nephrectomy: analysis of the current literature. Eur Urol. 2008;53:732–42.
Berger A, Crouzet S, Canes D, et al. Minimally invasive nephron-sparing surgery. Curr Opin Urol. 2008;18:462–6.
Khalifeh A, Kaouk JH, Bhayani S, et al. Positive surgical margins in robot-assisted partial nephrectomy: a multi-institutional analysis of oncologic outcomes (leave no tumor behind). J Urol. 2013;190:1674–9.
Lane BR, Campbell SC, Gill IS. 10-year oncologic outcomes after laparoscopic and open partial nephrectomy. J Urol. 2013;190:44–9.
Yu HY, Hevelone ND, Lipsitz SR, et al. Use, costs, and comparative effectiveness of robotic assisted, laparoscopic, and open urological surgery. J Urol. 2012;187:1392–8.
Acknowledgments
This study was conducted in the setting of the French Research Network on Kidney Cancer UroCCR.
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Karim Bensalah, Nicolas Doumerc, and Christophe Vaessen are consultants for Intuitive Surgical.
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Peyronnet, B., Seisen, T., Oger, E. et al. Comparison of 1800 Robotic and Open Partial Nephrectomies for Renal Tumors. Ann Surg Oncol 23, 4277–4283 (2016). https://doi.org/10.1245/s10434-016-5411-0
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DOI: https://doi.org/10.1245/s10434-016-5411-0