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