Introduction

Robotic approach is well-accepted standard for cT1a, however some urologists may question it for more complex cT1b lesions. We aimed to compare outcomes between robotic partial nephrectomy (RPN) and open partial nephrectomy (OPN) for moderately or highly complex (RENAL Score ≥7) T1b tumors.

Methods

We retrospectively reviewed 1230 consecutive cases, consisting of 823 RPN and 407 OPN, performed for renal mass at a single academic tertiary center between 2011 and 2016. Of these, data on 143 RPN and 78 OPN cases for moderately or highly complex T1b tumors. Baseline patient factors, and tumor characteristics, operative, postoperative, functional and oncologic outcomes were compared between groups.

Results

Apart from a higher age among OPN cases (59.7 vs. 64.2 yrs. p=0.01), demographic characteristics were similar between groups. No statistically significant differences were seen in tumor size (p=0.54) or margin status (p=0.83) between groups. The patients in the RPN group had less estimated blood loss (150 vs. 300 cc, p<0.01), lower intraoperative transfusion rates (2.1% vs. 12.8%, p<0.01), and shorter length of stay (3 vs. 5 days, p<0.01). Patients who underwent RPN were found to have lower overall (Clavien grade 1-5; 18.9 vs. 39.7 %, p<0.01), and lower major (Clavien grade 3-5; 4.2 vs. 15.4 %, p<0.01) complication rates. Multivariable logistic regression analysis demonstrated open approach (OR 2.8, CI 1.4-5.4, p=0.002) and high BMI (OR 1.05, CI 1.01-1.1, p=0.01) to be independent factors for overall complications. There was no difference in estimated glomerular filtration rate preservation rates between groups for early (p=0.2) and latest (p=0.1) functional follow-up. Oncological outcomes were similar between the two groups.

Conclusions

For moderately or highly complex T1b tumors RPN appears to be a safe and effective alternative to OPN with the advantages of shorter length of stay and less blood loss.

Funding

None