MP57: Kidney Cancer: Localized: Surgical Therapy IV
MP57-07: Comparisons of surgical outcomes between transperitoneal and retroperitoneal approaches in robot-assisted laparoscopic partial nephrectomy for lateral renal tumors: A propensity score-matched comparative analysis
Introduction: Surgical approaches, such as transperitoneal approach (TP) and retroperitoneal approach (RP), in robot-assisted laparoscopic partial nephrectomy (RAPN) are selected according to the tumor’s position or surgeons’ preference. In our institution, TP and RP are adopted for anterior and posterior tumors, respectively. However, we sometimes hesitate over the appropriate approach for lateral renal tumors. In the present study, we compared outcomes of RAPN for lateral tumors between TP and RP.
Methods: This study included patients who underwent RAPN for lateral renal tumors between 2013 and 2019. Lateral tumors were defined as X of A factors in the RENAL nephrometry score. In total, 290 patients with TP and 48 patients with RP were included in the analysis. To minimize the effects of selection bias, the following variables were adjusted using 1:1 propensity score matching: age, sex, body mass index (BMI), American Society of Anesthesiologists score, preoperative estimated glomerular filtration rate (eGFR), tumor size, and RENAL nephrometry score. Surgical outcomes compared between the groups included operation time (OT), console time, estimated blood loss (EBL), ischemia time, length of postoperative hospital stay (PLOS), change in eGFR, surgical margin status, and perioperative complications.
Results: After matching, 48 patients were allocated to each group. The mean age was 55 years, and the mean preoperative eGFR was 68–69 mL/min/1.73m2. The mean tumor size was 30–31 with approximately 40% and 45% of patients having low and intermediate complexity tumors, respectively. The RP group had a shorter OT (124 min vs. 151 min, p = 0.0002), shorter console time (74 min vs. 110 min, p < 0.0001), shorter warm ischemia time (14 min vs. 17 min, p = 0.0343), lower EBL (33ml vs. 52 ml, p = 0.0002), and shorter PLOS (3.3 days vs. 4.0 days, p < 0.0001). The change in eGFR, incidence rate of perioperative complication, and positive surgical margin rate did not significantly differ between the groups.
Conclusions: RP had better surgical outcomes, including shorter operation time, lower EBL, and shorter PLOS for lateral renal tumors, which may suggest that RP is the optimal approach for selected lateral renal tumors. Source of
.jpg "Toshio Takagi, MD photo")
