Long-term outcomes of minimally invasive surgeries in partial nephrectomy. Robot or laparoscopy?

摘要

Background: To compare long-term oncological and renal functional outcomes of laparoscopic and robotic partial nephrectomy for small renal masses. Methods: A total of 103 patients who underwent laparoscopic (n= 31) and robotic (n= 72) partial nephrectomy between April 2015 and November 2018 were included in the study. Perioperative parameters, long-term oncological and functional outcomes were compared between the laparoscopic and robotic groups. Results: No significant differences were found in terms of age, tumor size, RENAL and PADUA scores, preoperative estimated glomerular filtration rate (eGFR), and presence of chronic hypertension and diabetes (p=0.479, p=0.199, p=0.120 and p=0.073, p=0.561 and p=0.082 and p=0.518, respectively). Only estimated blood loss was significantly higher in the laparoscopic group in operative parameters (158.23±72.24 mL vs 121.11±72.17 mL; P=0.019), but transfusion rates were similar between the groups (p=0.33). In the laparoscopic group, two patients (6.5%) required conversion to open, while no conversion was needed in the robotic group (p=0.89). There were no differences in terms of positive surgical margin and complication rates (p=0.636 and p=0.829, respectively). No significant differences were observed in eGFR changes and postoperative new-onset chronic kidney disease at one year after the operation (p=0.768, p=0.614, respectively). The overall mean follow- up period was 36.07±13.56 months (p=0.007). During the follow-up period, no cancer-related death observed in both group and non-cancer specific survival was 93.5% and 94.4% in laparoscopic and robotic groups, respectively (p=0.859). Conclusions: In this study, perioperative and long-term oncological and functional outcomes seems to be comparable between laparoscopic and robotic partial nephrectomies.