Robotic partial nephrectomy versus radical nephrectomy in elderly patients with large renal masses

Abstract

BACKGROUND: Recent evidence suggests that the "oldest old" patients might benefit of partial nephrectomy (PN), but decision-making for this subset of patients is still controversial. aim of this study is to compare outcomes of robotic partial (rPN) or radical nephrectomy (rrN) for large renal masses in patients older than 65 years. METHODS: We identified 417≥65 years old patients who underwent RRN or RPN for cT1b or ≥cT2 renal mass at 17 high volume centers. Propensity score match analysis was performed adjusting for age, ASA≥3, pre-operative eGFR, and clinical tumor size. Predictors of complications, functional and oncological outcomes were evaluated in multivariable logistic and cox regression models. reSUlTS: after propensity score analysis, 73 patients in the rPN group were matched with 74 in the rrN group. r.e.N.a.l. Score (9.6±1.7 vs. 8.6±1.7; P<0.001), and high complexity (56 vs. 15%; P=0.001) were higher in the rrN. estimated blood loss was higher in the rPN group (200 vs. 100 ml; P<0.001). rPN showed higher rate of overall complications (38 vs. 23%; P=0.05), but not major complications (P=0.678). at last follow-up, rPN group showed better

Minimally invasive radical nephrectomy: a contemporary review

“…Recent propensity-matched comparisons have demonstrated that robotic partial nephrectomy for large (>7 cm) clinical T2a masses has similar safety profile and 5-year oncological outcomes compared to MI-RN with the added benefit of renal function preservation and improved 5-year freedom from stage 3 chronic kidney disease (109). Similar findings have been reported in the elderly population (110). With burgeoning expertise in complex robotic partial nephrectomy for large renal masses, the role of MI-RN for localized renal masses may become increasingly limited in the future.…”

Transperitoneal vs retroperitoneal minimally invasive partial nephrectomy: comparison of perioperative outcomes and functional follow-up in a large multi-institutional cohort (The RECORD 2 Project)

“…years paved the way for the gradually increased employment of minimally invasive approaches, first with the advent of laparoscopy and then with robotics, progressively minimizing the impact and invasiveness of surgical procedures [7][8][9].…”

Superior Mesenteric Artery Injury during Robotic Radical Nephrectomy: Scenarios and Management Strategies

“…There are several advantages of robotic technology to renal surgery, including an enhanced degree of freedom, three-dimensional visualization, higher magnification, surgeon’s ergonomics, the use of fluorescence imaging, and the elimination of tremors leading to a widespread utilization to perform more complex surgeries [ 5 , 6 , 7 , 8 , 9 , 10 ]. However, there is a potential risk for catastrophic complications during complex robotic renal surgery due to the close proximity of vital vascular structures [ 11 , 12 , 13 , 14 , 15 ].…”