Journal of laparoendoscopic & advanced surgical techniques. Part A | 2019
A Multi-Institutional Propensity Score Matched Comparison of Transperitoneal and Retroperitoneal Partial Nephrectomy for cT1 Posterior Tumors.
Abstract
OBJECTIVE\nTo compare the perioperative and renal functional outcome between transperitoneal and retroperitoneal robotic partial nephrectomy (TP-RPN and RP-RPN) in the largest cohort to date of RP-RPN for posterior tumors.\n\n\nMETHODS\nWe identified 519 patients who met eligibility criteria and underwent TP-RPN (n\u2009=\u2009357, 68.8%) or RP-RPN (n\u2009=\u2009162, 31.2%) for a posteriorly located cT1 tumor. Patients were propensity score (PS) matched on preoperative and tumor-specific characteristics. Perioperative outcome and renal function outcome at median follow-up 22 months were compared.\n\n\nRESULTS\nBetween the PS matched TP-RPN (n\u2009=\u2009157, 50%) and RP-RPN (n\u2009=\u2009157, 50%) patients, operative time (OT) (185.0 versus 157.0, P\u2009<\u2009.001) was longer in TP-RPN versus RP-RPN patients. No significant differences in ischemia time (P\u2009=\u2009.618), blood loss (P\u2009=\u2009.178), positive surgical margins (P\u2009=\u2009.501), overall postoperative complications (P\u2009=\u2009.861), or progression of chronic kidney disease stage at median 22 months (P\u2009=\u2009.599) were identified. Length of stay (LOS) was reduced in RP-RPN patients (P\u2009=\u2009.017), but was not different once an institution used a postoperative day (POD)-1 discharge protocol (P\u2009=\u2009.579). Operative times were similar between groups in patients with obesity (P\u2009=\u2009.293) or a cT1b renal mass (P\u2009=\u2009908).\n\n\nCONCLUSION\nRP-RPN for posterior tumors resulted in reduced OT and a shorter LOS compared to TP-RPN. When surgeons aimed to routinely discharge patients on POD-1, the surgical approach did not influence LOS. Operative time was similar between RP and TP-RPN among patients with obesity or a cT1b renal mass. All other measures, including ischemia time, blood loss, margin rates, complications, and renal function, did not differ between the two approaches.