Surgical experience and functional outcomes after laparoscopic and robot-assisted partial nephrectomy: Results from a multi-institutional collaboration

Introduction & Objectives: In patients treated with partial nephrectomy, prior evidence showed that peri-operative outcomes such as complications and ischemia time improved as a function of surgical experience of the surgeon, but data on functional outcomes after surgery is still scarce. Materials & Methods: We retrospectively analyzed data of 4,011 patients with a single, unilateral cT1a-b renal mass treated with laparoscopic or robot-assisted partial nephrectomy by 119 surgeons at 22 participating institutions between 1997 and 2022. Multivariable models investigated the association between surgical experience (number of prior operations) and acute kidney injury (AKI) and recovery of at least 90% of baseline estimated glomerular filtration rate (eGFR) 1 yr after partial nephrectomy. Results: A total of 753 (19%) and 3258 (81%) patients underwent laparoscopic and robot-assisted partial nephrectomy, respectively. Overall, 37 (31%) and 55 (46%) surgeons contributed only to laparoscopic and robotic learning curves, whereas 27 (23%) contributed to both approaches. In the laparoscopic group, 8% and 55% of patients developed AKI and recovered at least 90% of their baseline eGFR, respectively. After adjusting for confounders, we did not find evidence of an association between surgical experience and AKI after laparoscopic partial nephrectomy (p=0.6). Similar results were found when 1-year renal function was the outcome of interest (p=0.5). Among patients who underwent robot-assisted partial nephrectomy, AKI occurred in 11% of patients, whereas 54% recovered at least 90% of their baseline eGFR. On multivariable analyses, the relationship between surgical experience and AKI after surgery was not statistically significant (p=0.2), with similar results when the outcome of interest was renal function one year after surgery (p=0.9; Figure 1). Conclusions: In patients treated with laparoscopic or robot-assisted partial nephrectomy, our data suggests that surgical experience of the operating surgeon might not be a key determinant of functional recovery after surgery. This raises questions about the use of serum markers to assess functional recovery in patients with two kidneys, and opens the discussion on what are the key steps of the procedure that allowed surgeons to achieve optimal outcomes since their initial cases. analyzed separately.