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
- 1 February 2021
- journal article
- research article
- Published by Springer Science and Business Media LLC in Journal of Robotic Surgery
- Vol. 15 (1), 99-104
- https://doi.org/10.1007/s11701-020-01086-3
Abstract
Objective To compare the surgical outcomes between the transperitoneal (TP) and retroperitoneal (RP) approaches in robot-assisted laparoscopic partial nephrectomy (RAPN) for lateral tumors. 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 and 48 patients with TP and RP, respectively, 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, American Society of Anesthesiologists score, preoperative estimated glomerular filtration rate, tumor size, and RENAL nephrometry score. Results After matching, 48 patients were allocated to each group. The mean age was 55 years, and the mean preoperative estimated glomerular filtration rate (eGFR) was 68-69 mL/min/1.73 m(2). The mean tumor size was 30-31 mm. The RP group had a shorter operative time (124 vs. 151 min, p = 0.0002), shorter console time (74 vs. 110 min, p < 0.0001), shorter warm ischemic time (14 vs. 17 min, p = 0.0343), lower estimated blood loss (EBL) (33 vs. 52 ml, p = 0.0002), and shorter postoperative length of hospital stay (PLOS) (3.3 vs. 4.0 days, p < 0.0001) than the TP group. The change in eGFR, incidence rate of perioperative complication, and positive surgical margin rate did not significantly differ between the two groups. Conclusion RP had better surgical outcomes, including shorter operative time, lower EBL, and shorter PLOS for lateral renal tumors, which may suggest that RP is the optimal approach for selected lateral renal tumors.This publication has 12 references indexed in Scilit:
- Trans-peritoneal vs. retroperitoneal robotic assisted partial nephrectomy in posterior renal tumours: need for a risk-stratified patient individualised approach. A systematic review and meta-analysisJournal of Robotic Surgery, 2019
- A Multi-Institutional Propensity Score Matched Comparison of Transperitoneal and Retroperitoneal Partial Nephrectomy for cT1 Posterior TumorsJournal of Laparoendoscopic & Advanced Surgical Techniques, 2019
- Retroperitoneal Robotic Partial Nephrectomy: Systematic Review and Cumulative Analysis of Comparative OutcomesJournal of Endourology, 2018
- Retroperitoneal versus transperitoneal robotic-assisted laparoscopic partial nephrectomyCurrent Opinion in Urology, 2018
- Comparison of Kidney Function in the Early Postoperative Period in Transperitoneal Robot-Assisted Laparoscopic Partial Nephrectomy Between Anterior and Posterior Renal Tumors: A Propensity Score-Matched StudyJournal of Endourology, 2018
- Robotic Partial Nephrectomy for Posterior Tumors Through a Retroperitoneal Approach Offers Decreased Length of Stay Compared with the Transperitoneal Approach: A Propensity-Matched AnalysisJournal of Endourology, 2017
- Retroperitoneal Robot-Assisted Partial Nephrectomy for Posterior Renal Masses Is Associated with Earlier Hospital Discharge: A Single-Institution Retrospective ComparisonJournal of Endourology, 2015
- The R.E.N.A.L. Nephrometry Score: A Comprehensive Standardized System for Quantitating Renal Tumor Size, Location and DepthJournal of Urology, 2009
- Revised Equations for Estimated GFR From Serum Creatinine in JapanAmerican Journal of Kidney Diseases, 2009
- Classification of Surgical ComplicationsAnnals of Surgery, 2004