Robot-assisted vs. open partial nephrectomy for renal cell carcinoma – functional and oncological outcomes according to RENAL nephrometric score

Czech version

Authors: Veronika Lounová; Vladimír Študent Jr.
Authors‘ workplace: Urologická klinika LF UP a FN Olomouc
Published in: Ces Urol 2025; 29(2): 94-102
Category: Original article
doi: https://doi.org/10.48095/cccu2025015

Overview

Partial nephrectomy is currently the standard treatment for cT1 renal tumors. Although the robotic approach (RAPN) does not clearly demonstrate superiority over open surgery (OPN), it has gained popularity. This study aims to compare the perioperative, functional, and oncological outcomes of these modalities.

Objective: The study aims to compare the perioperative outcomes of robot-assisted partial nephrectomy (RAPN) and open partial nephrectomy (OPN), assessed according to tumor complexity using the RENAL nephrometric score. Patients and methods: The retrospective study included patients operated on between 2010 and 2020. Demographic data (age, body mass index, Charlson Comorbidity index, and gender), perioperative data (blood loss, length of hospitalization, complications, length of ischemia), and postoperative outcomes (histopathological findings and renal function) were compared. Results: 563 patients were evaluated, 306 OPN and 257 RAPN. Patients who underwent OPN were older (mean 64.3 vs. 61.6 years; P = 0.01), had a higher mean RENAL score (7.2 vs. 6.3; P < 0.01), and had more comorbidities (P < 0.01). Ischemia was used less in RAPN (60.8 vs. 65.8 %; P = 0.25) but was 3.5 min longer in RAPN (mean 17.5 vs. 14 min; P = 0.014). The operation was, on average, 7 min longer in RAPN (100.2 vs. 92.9 min; P = 0.007), but in the moderate complexity group (N = 279), no difference was found (P = 0.19). In the RAPN group, the average blood loss was half of that in the OPN group (149.9 vs. 301.9 ml; P < 0.001), the length of hospital stay was shorter (5.2 vs. 6.8 days; P < 0.01), as was the use of the intensive care unit (17 vs. 84%; P < 0.01). The rate of positive surgical margins was lower in RAPN (P = 0.04). The overall complication rate was comparable between RAPN and OPN (12.7 vs. 11.9%; P = 0.79), but OPN had a higher rate of serious complications (Clavien-Dindo ≥ 3b) at 20.5 vs. 11%. Postoperatively, RAPN had a smaller decrease in glomerular filtration rate in all groups (P = 0.04). Conclusion: RAPN shows better results than OPN regarding blood loss, preservation of renal function, length of hospital stay, and intensive care utilization. There is also a trend toward lower rates of serious complications and positive surgical margins.

Keywords:

nephron sparing surgery – renal carcinoma – robotic surgery – nephrometric score

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