Robotic and open partial nephrectomy for intermediate and high complexity tumors: a matched-pairs comparison of surgical outcomes at a single institution

Zain A. Abedali, M. Francesca Monn, Patrick Huddleston, Brent E. Cleveland, Jay Sulek, Clinton Bahler, Richard S. Foster, Michael O. Koch, Matthew J. Mellon, Hristos Kaimakliotis, Clint Cary, Richard Bihrle, Thomas A. Gardner, Timothy A. Masterson, Ronald S. Boris, Chandru P. Sundaram

Research output: Contribution to journalArticle

Abstract

Objective: To compare peri-operative factors and renal function following open partial nephrectomy (OPN) and robotic partial nephrectomy (RPN) for intermediate and high complexity tumors when controlling for tumor and patient complexity. Methods: A retrospective review of 222 patients undergoing partial nephrectomy was performed. Patients with intermediate (nephrometry score NS 7–9) or high (NS 10–12) complexity tumors were matched 2:1 for RPN:OPN using NS, Charlson Comorbidity Index (CCI), and BMI. Patient demographics, peri-operative values, renal function, and complication rates were analyzed and compared. Results: Seventy-four OPN patients were matched to 148 RPN patients with no difference in patient demographics. Estimated blood loss in OPN patients was significantly higher (368.5 vs 210.5 mL, p < 0.001) as was transfusion rate (17% vs 1.6%, p < 0.001). Warm ischemia time was longer in OPN (25.5 vs 19.7 min, p = 0.001) while operative time was reduced (200.5 vs 226.5 min, p = 0.010). RPN patients had significantly shorter hospitalizations (5.3 vs 3.0 days, p < 0.001). GFR decrease after one month was not statistically significant (12.9 vs 6.6 ml/min, p = 0.130). Clavien III–V complications incidence was higher for OPN compared to RPN although not significantly (20.3% vs 10.8%, p = 0.055). Conclusion: When matching for tumor and patient complexity, RPN patients had fewer high grade post-operative complications, decreased blood loss, and shorter hospitalizations. RPN is a safe option for patients with intermediate and high complexity tumors.

Original languageEnglish (US)
JournalScandinavian Journal of Urology
DOIs
StateAccepted/In press - Jan 1 2020

Keywords

  • laparoscopy
  • partial nephrectomy
  • renal tumors
  • Robotic surgery

ASJC Scopus subject areas

  • Nephrology
  • Urology

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