Partial nephrectomy in clinical T1b renal tumors : multicentre comparative study of open, laparoscopic and robot-assisted approach (the RECORd Project)

OBJECTIVES: To evaluate perioperative results of open (OPN), laparoscopic (LPN) and robot-assisted partial nephrectomy (RAPN) and to identify predictive factors of Trifecta achievement for clinical T1b renal tumors in a multicenter prospective dataset.METHODS: Data of 285 patients who had OPN (133), LPN (57) or RAPN (95) for cT1b renal tumors were extracted from the RECORd Project. High volume centers were defined as ≥ 50 overall cases of partial nephrectomy per year. Trifecta was defined as simultaneous absence of perioperative complications, negative surgical margins, ischemia time <25 minutes. RESULTS: The three groups had comparable BMI, preoperative haemoglobin, creatinine and eGFR, tumor clinical diameter and growth pattern. LPN and RAPN were more frequently exclusive of high volume centers. RAPN showed significantly lower median estimated blood loss compared to OPN and LPN. Trifecta was achieved in 62.4%, 63.2% and 69.5% OPN, LPN and RAPN (p=NS). Median WIT was significantly shorter during OPN than during LPN and RAPN. RAPN had significantly shorter WIT compared to LPN. RAPN was significantly less morbid than OPN regarding intraoperative and postoperative complications. LPN (1.9%) and RAPN (2.5%) showed a lower rate of positive margins compared to OPN (6.8%) (p=NS). At multivariable analysis, exophytic tumor growth pattern, estimated blood loss and high volume centers were significant predictive factors for Trifecta achievement. CONCLUSIONS: Clinically T1b renal tumors suitable for NSS can be safely treated by LPN or RAPN in high volume centers. RAPN allows for significantly lower WIT and EBL with higher rate of Trifecta achievement compared to LPN.