J Korean Med Sci.  2021 May;36(20):e135. 10.3346/jkms.2021.36.e135.

Open Partial Nephrectomy vs. Robotassisted Partial Nephrectomy for a Renal Tumor Larger than 4 cm: a Propensity Score Matching Analysis

Affiliations
  • 1Department of Urology, Seoul National University Bundang Hospital, Seongnam, Korea
  • 2Department of Urology, Ewha Womans University College of Medicine, Seoul, Korea
  • 3Department of Urology, Kyung Hee University Medical Center, Kyung Hee University College of Medicine, Seoul, Korea

Abstract

Background
To compare open partial nephrectomy (OPN) and robot-assisted partial nephrectomy (RAPN) in the management of renal tumors larger than 4 cm.
Methods
Clinical records of 220 patients who underwent OPN or RAPN for a single renal tumor ≥ 4.0 cm with a normal contralateral kidney were reviewed. After determining the propensity score, surgical parameters, functional outcomes, and oncological outcomes were compared between OPN (n = 67) and RAPN (n = 67) groups of patients.
Results
The RAPN group had longer operation time (149.0 min vs. 173.3 min, P = 0.030) and longer ischemic time (20.3 min vs. 29.4 min, P = 0.001), but shorter hospital stay (8.2 days vs 6.0 days, P = 0.001) than the OPN group. Estimated blood loss (P = 0.053), pain visual analog score at 1 day postoperatively (P = 0.194), and complications of grade III or higher (P = 0.403) were similar between OPN and RAPN groups. There was no radical conversion or positive surgical margin in either group. Mean change in 6-month estimated glomerular filtration rate was significantly better in the RAPN group (−8.2 vs. −3.1, P = 0.027). There was no statistical difference in recurrence-free survival (P = 0.970) or cancer-specific survival (P = 0.345) between the two groups.
Conclusion
RAPN is a safe and feasible surgical modality comparable to OPN for managing renal tumors larger than 4 cm in terms of surgical, functional, and oncological outcomes.

Keyword

Open Partial Nephrectomy; Robot-assisted Partial Nephrectomy; Renal Tumor

Figure

  • Fig. 1 Probability of recurrence-free survival (A) and cancer-specific survival (B) in patients who underwent OPN or RAPN for a single unilateral renal tumor larger than 4 cm with a normal contralateral kidney.OPN = open partial nephrectomy, RAPN = robot-assisted partial nephrectomy.


Reference

1. Lau WK, Blute ML, Weaver AL, Torres VE, Zincke H. Matched comparison of radical nephrectomy vs nephron-sparing surgery in patients with unilateral renal cell carcinoma and a normal contralateral kidney. Mayo Clin Proc. 2000; 75(12):1236–1242. PMID: 11126830.
Article
2. Lee JW, Kim H, Choo M, Park YH, Ku JH, Kim HH, et al. Different methods of hilar clamping during partial nephrectomy: impact on renal function. Int J Urol. 2014; 21(3):232–236. PMID: 24033600.
Article
3. Leibovich BC, Blute M, Cheville JC, Lohse CM, Weaver AL, Zincke H. Nephron sparing surgery for appropriately selected renal cell carcinoma between 4 and 7 cm results in outcome similar to radical nephrectomy. J Urol. 2004; 171(3):1066–1070. PMID: 14767272.
Article
4. Patard JJ, Pantuck AJ, Crepel M, Lam JS, Bellec L, Albouy B, et al. Morbidity and clinical outcome of nephron-sparing surgery in relation to tumour size and indication. Eur Urol. 2007; 52(1):148–154. PMID: 17240036.
Article
5. Li W, Cheng Y, Cheng Y, Ren H, Han N. Clinical efficacy of radical nephrectomy versus nephron-sparing surgery on localized renal cell carcinoma. Eur J Med Res. 2014; 19(1):58. PMID: 25374003.
Article
6. Tufek I, Mourmouris P, Doganca T, Obek C, Argun OB, Tuna MB, et al. Robot-assisted partial nephrectomy for T1b tumors: strict trifecta outcomes. JSLS. 2017; 21(1):e2016.00113.
Article
7. Boulière F, Crepel M, Bigot P, Pignot G, Bessede T, de la Taille A, et al. Nephron-sparing surgery is superior to radical nephrectomy in preserving renal function outcome in tumors larger than 4 cm. Prog Urol. 2011; 21(12):842–850. PMID: 22035910.
8. Crépel M, Jeldres C, Perrotte P, Capitanio U, Isbarn H, Shariat SF, et al. Nephron-sparing surgery is equally effective to radical nephrectomy for T1BN0M0 renal cell carcinoma: a population-based assessment. Urology. 2010; 75(2):271–275. PMID: 19962740.
Article
9. Peyronnet B, Seisen T, Oger E, Vaessen C, Grassano Y, Benoit T, et al. Comparison of 1800 robotic and open partial nephrectomies for renal tumors. Ann Surg Oncol. 2016; 23(13):4277–4283. PMID: 27411552.
Article
10. Benway BM, Bhayani SB, Rogers CG, Dulabon LM, Patel MN, Lipkin M, et al. Robot assisted partial nephrectomy versus laparoscopic partial nephrectomy for renal tumors: a multi-institutional analysis of perioperative outcomes. J Urol. 2009; 182(3):866–872. PMID: 19616229.
Article
11. Mottrie A, Borghesi M, Ficarra V. Is traditional laparoscopy the real competitor of robot-assisted partial nephrectomy? Eur Urol. 2012; 62(6):1034–1036. PMID: 22854247.
Article
12. Levey AS, Stevens LA, Schmid CH, Zhang YL, Castro AF 3rd, Feldman HI, et al. A new equation to estimate glomerular filtration rate. Ann Intern Med. 2009; 150(9):604–612. PMID: 19414839.
Article
13. Hafez KS, Fergany AF, Novick AC. Nephron sparing surgery for localized renal cell carcinoma: impact of tumor size on patient survival, tumor recurrence and TNM staging. J Urol. 1999; 162(6):1930–1933. PMID: 10569540.
Article
14. Antonelli A, Cozzoli A, Nicolai M, Zani D, Zanotelli T, Perucchini L, et al. Nephron-sparing surgery versus radical nephrectomy in the treatment of intracapsular renal cell carcinoma up to 7cm. Eur Urol. 2008; 53(4):803–809. PMID: 18036730.
Article
15. Pahernik S, Roos F, Röhrig B, Wiesner C, Thüroff JW. Elective nephron sparing surgery for renal cell carcinoma larger than 4 cm. J Urol. 2008; 179(1):71–74. PMID: 17997423.
Article
16. Shum CF, Bahler CD, Sundaram CP. Matched comparison between partial nephrectomy and radical nephrectomy for T2 N0 M0 tumors, a study based on the National Cancer Database. J Endourol. 2017; 31(8):800–805. PMID: 28486848.
Article
17. Ficarra V, Bhayani S, Porter J, Buffi N, Lee R, Cestari A, et al. Predictors of warm ischemia time and perioperative complications in a multicenter, international series of robot-assisted partial nephrectomy. Eur Urol. 2012; 61(2):395–402. PMID: 22079308.
Article
18. Patel HD, Mullins JK, Pierorazio PM, Jayram G, Cohen JE, Matlaga BR, et al. Trends in renal surgery: robotic technology is associated with increased use of partial nephrectomy. J Urol. 2013; 189(4):1229–1235. PMID: 23085300.
Article
19. Hanzly M, Frederick A, Creighton T, Atwood K, Mehedint D, Kauffman EC, et al. Learning curves for robot-assisted and laparoscopic partial nephrectomy. J Endourol. 2015; 29(3):297–303. PMID: 25111313.
Article
20. Shen Z, Xie L, Xie W, Hu H, Chen T, Xing C, et al. The comparison of perioperative outcomes of robot-assisted and open partial nephrectomy: a systematic review and meta-analysis. World J Surg Oncol. 2016; 14(1):220. PMID: 27549155.
Article
21. Xia L, Wang X, Xu T, Guzzo TJ. Systematic review and meta-analysis of comparative studies reporting perioperative outcomes of robot-assisted partial nephrectomy versus open partial nephrectomy. J Endourol. 2017; 31(9):893–909. PMID: 27305835.
Article
22. Godoy G, Ramanathan V, Kanofsky JA, O'Malley RL, Tareen BU, Taneja SS, et al. Effect of warm ischemia time during laparoscopic partial nephrectomy on early postoperative glomerular filtration rate. J Urol. 2009; 181(6):2438–2443. PMID: 19371905.
Article
23. Thompson RH, Lane BR, Lohse CM, Leibovich BC, Fergany A, Frank I, et al. Every minute counts when the renal hilum is clamped during partial nephrectomy. Eur Urol. 2010; 58(3):340–345. PMID: 20825756.
Article
24. Lee C, Kwon T, Yoo S, Jung J, Lee C, You D, et al. Comparison of renal function between robot-assisted and open partial nephrectomy as determined by Tc 99m-DTPA renal scintigraphy. J Korean Med Sci. 2016; 31(5):743–749. PMID: 27134496.
Article
25. Simmons MN, Fergany AF, Campbell SC. Effect of parenchymal volume preservation on kidney function after partial nephrectomy. J Urol. 2011; 186(2):405–410. PMID: 21680004.
Article
26. Simmons MN, Lieser GC, Fergany AF, Kaouk J, Campbell SC. Association between warm ischemia time and renal parenchymal atrophy after partial nephrectomy. J Urol. 2013; 189(5):1638–1642. PMID: 23159462.
Article
Full Text Links
  • JKMS
Actions
Cited
CITED
export Copy
Close
Share
  • Twitter
  • Facebook
Similar articles
Copyright © 2024 by Korean Association of Medical Journal Editors. All rights reserved.     E-mail: koreamed@kamje.or.kr