Robot-Assisted versus Laparoscopic Partial Nephrectomy for Giant Sporadic Renal Angiomyolipomas of ≥7 cm: A Propensity Score-Matched Analysis

Abstract

Background. To compare the perioperative and functional outcomes between robot-assisted partial nephrectomy (RAPN) and laparoscopic partial nephrectomy (LPN) for giant sporadic renal angiomyolipomas (AMLs) of ≥7 cm. Materials and Methods. Patients with sporadic renal AMLs of ≥7 cm who underwent RAPN or LPN in the First Affiliated Hospital of Nanchang University between 2015 and 2020 were retrospectively analyzed. Propensity score matching (1 : 1) was performed to adjust for potential baseline confounders. Perioperative and functional outcomes of the RAPN and LPN groups were collected and compared. Result. After propensity score matching, no statistically significant differences in baseline characteristics were found between the groups (41 vs. 41). Within the matched cohort, the warm ischemia time (WIT) in the RAPN group was significantly shorter than that in the LPN group (21 vs. 27 min, p < 0.001 ). In addition, the RAPN group was associated with improved postoperative renal function (72.8 vs. 69.8 mL/min/1.73 m2, p = 0.045 ). WIT and preoperative renal function are independent predictors of renal function at 6 months postoperatively, and renal score and operation method are independent predictors of WIT. Conclusion. RAPN and LPN are safe and feasible minimally invasive treatments for sporadic giant renal AMLs, but RAPN is associated with shorter WIT and better postoperative renal functional preservation. WIT and preoperative renal function are independent predictors of renal function at 6 months postoperatively, while the RENAL score and surgical method are independent risk factors to WIT. For giant and complex renal AMLs, RAPN is the first choice when condition permits.

Comparisons of the safety and effectiveness of robot-assisted versus laparoscopic partial nephrectomy for central renal angiomyolipomas: A propensity score-matched analysis

“…A previous clinical comparison study reported [28] that the median WIT of LPN in the treatment of giant AMLs (62 patients with a mean tumor size of 8 cm and a mean renal score of 8) was 22 min, compared with only 17 min in the RAPN group (62 patients with a mean tumor size of 8 cm and a mean renal score of 9). Other similar clinical studies also reported WITs that were generally shorter than those reported in our study [23] .…”

“…Even for patients with the same disease that require surgical intervention, the surgical complications and postoperative outcomes are markedly different depending on the surgical modality chosen. More studies have reported surgical interventions for AMLs involving RAPN, LPN, selective arterial embolization, laparoscopic aspiration, microwave ablation, radiofrequency ablation, and traditional open surgery; they have also included a variety of patients as study subjects, such as patients with giant, bleeding, and central tumor types, but the conclusions reached vary and need to be veri ed by more studies [2,13,[21][22][23][24] . However, there have been no studies that focus speci cally on central renal angiomyolipomas.…”

Comparing the outcomes of open, laparoscopic and robot‐assisted partial nephrectomy: a network meta‐analysis

“…There were 31 studies included in the NMA [9,16,21,30–57]. This comprised of one RCT, four prospective studies and 26 retrospective studies (30 propensity score matching studies).…”

“…Publication dates ranged from 2008 to 2021. Study data from the 31 included studies are outlined in Table 1 [9,16,21,30–57]. Risk of bias assessment for the RCT included in this study is outlined in Appendix S1.…”

“…Such improvements in WIT likely reflect the technically challenging aspect of the laparoscopic approach. The shortened WIT in RAPN was shown to have an associated improvement in the preservation of renal function postoperatively in several studies, further highlighting the potential benefits of a robot‐assisted approach [16,37,38,44,51,60].…”