Analysis of the Transperitoneal Approach to Robot-Assisted Laparoscopic Partial Nephrectomy for the Treatment of Anterior and Posterior Renal Masses

摘要

OBJECTIVE: Few studies have directly assessed the impact of tumor anterior/posterior location during transperitoneal robotic-assisted laparoscopic partial nephrectomy (TPRPN). The present study sought to assess perioperative and pathological outcomes associated with TPRPN among patients with anterior versus posterior tumors. PATIENTS AND METHODS: The Institutional Review Board-approved Mount Sinai Kidney Cancer database was used to identify 123 patients who underwent TPRPN from May 2011 to April 2015. Perioperative outcomes, including operative time, warm ischemia time (WIT), estimated blood loss (EBL), hospital length of stay (LOS), surgical margin status, complications, and reduction in estimated glomerular filtration rate (eGFR) at discharge and at last follow-up, were compared between those with anterior and posterior masses while controlling for clinical and pathological variables (i.e., age, gender, body mass index, tumor size, tumor laterality, malignancy, hilar location, and R.E.N.A.L. nephrometry score). RESULTS: Clinical and pathological characteristics were comparable between groups; mean tumor size was 3.1 cm anterior versus 2.8 cm posterior (P = .187). Tumor complexity (i.e., nephrometry scores, 6.9 versus 6.3; P = .097) and proportion of malignancy (74.5% versus 73.1%; P = .799) were also similar between posterior and anterior masses. In multivariable analyses, perioperative outcomes, including operative time, WIT, EBL, LOS, surgical margin status, reduction in eGFR, and postoperative complication rates, did not significantly differ between groups. CONCLUSIONS: The transperitoneal approach to partial nephrectomy for posterior tumors resulted in no difference in operative time, WIT, EBL, LOS, positive surgical margins, reduction in eGFR, or postoperative complications. The TPRPN approach to treat a posterior tumor is reasonable and is the preferred technique at our institution.