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)

Abstract

Background Aim of this study was to evaluate and compare perioperative outcomes of transperitoneal (TP) and retroperitoneal (TR) approaches in a multi-institutional cohort of minimally invasive partial nephrectomy (MI-PN). Material and methods All consecutive patients undergone MI-PN for clinical T1 renal tumors at 26 Italian centers (RECORd2 project) between 01/2013 and 12/2016 were evaluated, collecting the pre-, intra-, and postoperative data. The patients were then stratified according to the surgical approach, TP or RP. A 1:1 propensity score (PS) matching was performed to obtain homogeneous cohorts, considering the age, gender, baseline eGFR, surgical indication, clinical diameter, and PADUA score. Results 1669 patients treated with MI-PN were included in the study, 1256 and 413 undergoing TP and RP, respectively. After 1:1 PS matching according to the surgical access, 413 patients were selected from TP group to be compared with the 413 RP patients. Concerning intraoperative variables, no differences were found between the two groups in terms of surgical approach (lap/robot), extirpative technique (enucleation vs standard PN), hilar clamping, and ischemia time. Conversely, the TP group recorded a shorter median operative time in comparison with the RP group (115 vs 150 min), with a higher occurrence of intraoperative overall, 21 (5.0%) vs 9 (2.1%); p = 0.03, and surgical complications, 18 (4.3%) vs 7 (1.7%); p = 0.04. Concerning postoperative variables, the two groups resulted comparable in terms of complications, positive surgical margins and renal function, even if the RP group recorded a shorter median drainage duration and hospital length of stay (3 vs 2 for both variables), p < 0.0001. Conclusions The results of this study suggest that both TP and RP are feasible approaches when performing MI-PN, irrespectively from tumor location or surgical complexity. Notwithstanding longer operative times, RP seems to have a slighter intraoperative complication rate with earlier postoperative recovery when compared with TP.

Retroperitoneal Robot-assisted Partial Nephrectomy: A Systematic Review and Pooled Analysis of Comparative Outcomes

“…Concerning postoperative outcomes, our analysis reported a shorter LOS for patients who underwent R-RAPN (WMD: 0.35 d; p = 0.002). In a recent study, Porpiglia et al [38] compared the retroperitoneal and transperitoneal approaches in 1669 patients who were treated with minimally invasive partial nephrectomy at 26 Italian centers. Overall, the R-RAPN group presented a shorter median LOS (2 vs 3 d; p < 0.0001).…”

Nephrometry scores: a validation of three systems for peri‐operative outcomes in retroperitoneal robot‐assisted partial nephrectomy

“…We are able to use this approach in the vast majority of cases, with comparable outcomes to transperitoneal series [5] and only use the transperitoneal approach for anterior hilar tumours (7.4% in the present study). A recently published multi‐institutional matched comparative study of 826 retroperitoneal and transperitoneal RAPNs showed a longer OT for the retroperitoneal approach (115 vs 150 min), but a higher rate of intra‐operative complications (4.3% vs 1.7%) and longer LOS (3 vs 2 days) for the transperitoneal approach, although the results of that study are limited by selection bias [17].…”

Comparison of Posterior Retroperitoneoscopic Adrenalectomy Versus Lateral Transperitoneal Laparoscopic Adrenalectomy for Adrenal Tumors: A Systematic Review and Meta-Analysis

“…A largest matched pair multi-institutional study in minimally invasive partial nephrectomy, showed that retroperitoneal approach seemed to have a slighter intraoperative complication rate, longer operative times and earlier postoperative recovery when compared with transperitoneal ( 28 ). Although the approach was not exactly the same, it was also confirmed from the side that retroperitoneal approach was better in the overall curative effect of urological surgery.…”