gms | German Medical Science

63. Jahrestagung der Südwestdeutschen Gesellschaft für Urologie e. V.

Südwestdeutsche Gesellschaft für Urologie e. V.

21.-24.06.2023, Reutlingen

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Comparison of peri- and intraoperative outcomes of open vs robotic-assisted partial nephrectomy for renal cell carcinoma: A propensity matched analysis

Meeting Abstract

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  • Benedikt Hoeh - Klinik für Urologie, Goethe Universität Frankfurt
  • M. Wenzel - Klinik für Urologie, Goethe Universität Frankfurt
  • O. Eckhart - Klinik für Urologie, Goethe Universität Frankfurt
  • F. Fleisgarten - Klinik für Urologie, Goethe Universität Frankfurt
  • Garcia Cano - Klinik für Urologie, Goethe Universität Frankfurt
  • J. Köllermann - Dr. Senckenberg Institute of Pathology, Goethe Universität Frankfurt
  • C. Würnschimmel - Klinik für Urologie, Luzerner Kantonspital
  • A. Larcher - Division of Experimental Oncology/Unit of Urology, URI, Urological Research Institute, IRCCS San Raffaele Scientific Institute
  • P. Karakiewicz - Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montreal Health Center
  • L. Kluth - Klinik für Urologie, Goethe Universität Frankfurt
  • F. Chun - Klinik für Urologie, Goethe Universität Frankfurt
  • P. Mandel - Klinik für Urologie, Goethe Universität Frankfurt
  • A. Becker - Klinik für Urologie, Goethe Universität Frankfurt

Südwestdeutsche Gesellschaft für Urologie e.V.. 63. Jahrestagung der Südwestdeutschen Gesellschaft für Urologie e.V.. Reutlingen, 21.-24.06.2023. Düsseldorf: German Medical Science GMS Publishing House; 2023. DocV6.5

doi: 10.3205/23swdgu054, urn:nbn:de:0183-23swdgu0543

Veröffentlicht: 20. Juni 2023

© 2023 Hoeh et al.
Dieser Artikel ist ein Open-Access-Artikel und steht unter den Lizenzbedingungen der Creative Commons Attribution 4.0 License (Namensnennung). Lizenz-Angaben siehe http://creativecommons.org/licenses/by/4.0/.

Gliederung

Text

Objective: Partial nephrectomy (PN) is the gold standard surgical treatment for resectable renal cell carcinoma (RCC) tumors. However, the decision whether a robotic (RAPN) or open PN (OPN) approach is chosen, is often based on surgeon’s individual experience and preference. To overcome the inherent selection bias when comparing peri- and postoperative outcomes of RAPN vs. OPN a strict statistical methodology is needed.

Materials and methods: We relied on an institutional tertiary-care database to identify RCC patients treated with RAPN and OPN between 01/2002–01/2021. Study endpoints were estimated blood loss (EBL), length of stay (LOS), rate of intraoperative and postoperative complications and trifecta. In the first step of analyses, descriptive statistics and multivariable regressions models (MVA) were applied. In the second step of analyses, to validate initial findings, MVA were applied after 2:1 propensity-score matching (PSM).

Results: Of 615 RCC patients, 481 (78%) underwent OPN vs. 134 (22%) RAPN. RAPN patients were younger and presented with smaller tumor-diameter and lower RENAL-Score sum, respectively. Median EBL was comparable, whereas LOS was shorter in RAPN vs. OPN. Both intraoperative (27 vs. 6%) and Clavien-Dindo >2 complications (11 vs. 3%) were higher in OPN (both <0.05), whereas achievement of trifecta was higher in RAPN (65 vs. 54%; p=0.028). In MVA, RAPN was a significant predictor for shorter LOS, lower rates of intraoperative and postoperative complications as well as higher trifecta rates. After 2:1 PSM with subsequent MVA, RAPN remained a statistical and clinical predictor for lower rates of intraoperative and postoperative complications, and higher rates of trifecta achievement but not LOS.

Conclusions: Differences in baseline and outcome characteristics exist between RAPN vs. OPN, probably due to selection bias. However, after applying two sets of statistical analyses, RAPN seems to be associated with more favorable outcomes regarding complications and trifecta rates.