Robotic partial nephrectomy vs minimally invasive radical nephrectomy for clinical T2a renal mass: a propensity score‐matched comparison from the ROSULA (Robotic Surgery for Large Renal Mass) Collaborative Group

摘要

Objective To compare outcomes of minimally invasive radical nephrectomy (MIS‐RN) and robot‐assisted partial nephrectomy (RAPN) in clinical T2a renal mass (cT2aRM). Patients and Methods Retrospective, multicentre, propensity score‐matched (PSM) comparison of RAPN and MIS‐RN for cT2aRM (T2aN0M0). Cohorts were PSM for age, sex, body mass index, American Society of Anesthesiologists (ASA) class, clinical tumour size, and R.E.N.A.L. score using a 2:1 ratio for RN:PN. The primary outcome was disease‐free survival (DFS). Secondary outcomes included overall survival (OS), complication rates, and de novo estimated glomerular filtration rate (eGFR) <45 mL/min/1.73 m 2 . Multivariable (MVA) and Kaplan–Meier survival analyses (KMSA) were conducted. Results In all, 648 patients (216 RAPN/432 MIS‐RN) were matched. There were no significant differences in intraoperative complications ( P = 0.478), Clavien–Dindo Grade ≥III complications ( P = 0.063), and re‐admissions ( P = 0.238). The MVA revealed high ASA class (hazard ratio [HR] 2.7, P = 0.044) and sarcomatoid (HR 5.3, P = 0.001), but not surgery type ( P = 0.601) to be associated with all‐cause mortality. Increasing R.E.N.A.L. score (HR 1.31, P = 0.037), high tumour grade (HR 2.5, P = 0.043), and sarcomatoid (HR 2.8, P = 0.02) were associated with recurrence, but not surgery ( P = 0.555). Increasing age (HR 1.1, P < 0.001) and RN (HR 3.9, P < 0.001) were predictors of de novo eGFR of <45 mL/min/1.73 m 2 . Comparing RAPN and MIS‐RN, KMSA revealed no significant differences for 5‐year OS (76.3% vs 88.0%, P = 0.221) and 5‐year DFS (78.6% vs 85.3%, P = 0.630) for pT2 RCC, and no differences for 3‐year OS ( P = 0.351) and 3‐year DFS ( P = 0.117) for pT3a upstaged RCC. The 5‐year freedom from de novo eGFR of <45 mL/min/1.73 m 2 was 91.6% for RAPN vs 68.9% for MIS‐RN ( P < 0.001). Conclusions RAPN had similar oncological outcomes and morbidity profile as MIS‐RN, while conferring functional benefit. RAPN may be considered as a first‐line option for cT2aRM.