Robotic versus open partial nephrectomy for highly complex renal masses: Comparison of perioperative, functional, and oncological outcomes

Introduction: We aimed to compare perioperative, functional and oncological outcomes between robot-assisted partial nephrectomy (RAPN) and open partial nephrectomy (OPN) for highly complex renal tumors (R.E.N.A.L. nephrometry Score > 9). Methods: A retrospective review of 1,497 patients who consecutively underwent partial nephrectomy at a single academic tertiary center between 2008 and 2016 was performed to get data about patients who underwent RAPN and OPN for renal masses with RENAL score > 9. Baseline, perioperative, functional, and oncological outcomes were compared. Results: Two hundred and three RAPN and 76 OPN were extracted. Patients' demographics and tumors' characteristics were comparable between the groups. Blood loss (200 vs. 300 cc, P < 0.0001), intraoperative transfusion rates (3% vs. 15.8%, P < 0.001), and length of stay (3 vs. 5 days, P < 0.01) were lower for RAPN. A significant decrease in estimated glomerular filtration rate was observed from preoperative to postoperative period, regardless the approach (OPN, P = 0.026 vs. RAPN, P = 0.014). Conversion to radical nephrectomy was 7.8% and 5.9% for OPN and RAPN, respectively. At multivariable regression, open approach was predictive of intraoperative transfusion and reoperation. Overall actuarial rate of recurrence or metastasis was 4.3%, with 3 cancer-related deaths occurring after a median follow-up of 25 months. No differences were found between the groups. Conclusion: In our large single-institutional series of patients who underwent partial nephrectomy for highly complex renal tumors, robotic approach appeared to be a valuable alternative to OPN, with the advantages of reduced blood loss, ischemia time, transfusions rate, and length of stay.