Comparison of perioperative outcomes of robotic versus laparoscopic partial nephrectomy for complex renal tumors (RENAL nephrometry score of 7 or higher).
PURPOSE
To compare the perioperative outcomes of laparoscopic partial nephrectomy (LPN) and robotic partial nephrectomy (RPN) for moderately or highly complex tumors (RENAL nephrometry score ≥ 7).


MATERIALS AND METHODS
A retrospective analysis was performed for 127 consecutive patients who underwent either LPN (n=38) or RPN (n=89) between 2007 and 2013. Perioperative outcomes were compared.


RESULTS
There were no significant differences between the two groups with respect to patient gender, laterality, RENAL nephrometry score, or body mass index. The RPN group had a slightly higher RENAL nephrometry score (7.8 vs. 7.5, p=0.061) and larger tumor size (3.0 cm vs. 2.5 cm, p=0.044) but had a lower Charlson comorbidity index (3.7 vs. 4.4, p=0.017) than did the LPN group. There were no significant differences with respect to warm ischemia time, estimated blood loss, intraoperative complications, or operative time. Only one patient who underwent LPN had a positive surgical margin. There were statistically significant differences in surgical marginal width between the LPN and RPN groups (0.6 cm vs. 0.4 cm, p=0.001). No significant differences in postoperative complications were found between the two groups. Owing to potential baseline differences between the two groups, we performed a propensity-based matching analysis, in which differences in surgical margin width between the LPN and RPN groups remained statistically significant (0.6 cm vs. 0.4 cm, p=0.029).


CONCLUSIONS
RPN provides perioperative outcomes comparable to those of LPN and has the advantage of healthy parenchymal preservation for complex renal tumors (RENAL score ≥ 7).
['Jang|Hyeon Jun|HJ|', 'Song|Wan|W|', 'Suh|Yoon Seok|YS|', 'Jeong|U Seok|US|', 'Jeon|Hwang Gyun|HG|', 'Jeong|Byong Chang|BC|', 'Jeon|Seong Soo|SS|', 'Lee|Hyun Moo|HM|', 'Choi|Han Yong|HY|', 'Seo|Seong Il|SI|']
D000328:Adult D000368:Aged D002292:Carcinoma, Renal Cell D005260:Female D005919:Glomerular Filtration Rate D006801:Humans D007680:Kidney Neoplasms D010535:Laparoscopy D008297:Male D008875:Middle Aged D009392:Nephrectomy D012189:Retrospective Studies D065287:Robotic Surgical Procedures D012720:Severity of Illness Index D016896:Treatment Outcome
Robotics Nephrectomy Laparoscopy Renal cell carcinoma