TY - JOUR
T1 - Comparison of perioperative outcomes following transperitoneal versus retroperitoneal robot-assisted partial nephrectomy
T2 - a propensity-matched analysis of VCQI database
AU - Sharma, Gopal
AU - Shah, Milap
AU - Ahluwalia, Puneet
AU - Dasgupta, Prokar
AU - Challacombe, Benjamin J.
AU - Bhandari, Mahendra
AU - Ahlawat, Rajesh
AU - Rawal, Sudhir
AU - Buffi, Nicolo M.
AU - Sivaraman, Ananthkrishnan
AU - Porter, James R.
AU - Rogers, Craig
AU - Mottrie, Alexandre
AU - Abaza, Ronney
AU - Rha, Khoon Ho
AU - Moon, Daniel
AU - Yuvaraja, Thyavihally B.
AU - Parekh, Dipen J.
AU - Capitanio, Umberto
AU - Maes, Kris K.
AU - Porpiglia, Francesco
AU - Turkeri, Levent
AU - Gautam, Gagan
N1 - Funding Information:
Authors would like to thank Vattikuti Foundation for providing data.
Publisher Copyright:
© 2022, The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.
PY - 2022/9
Y1 - 2022/9
N2 - Objective: To compare perioperative outcomes following retroperitoneal robot-assisted partial nephrectomy (RPRAPN) and transperitoneal robot-assisted partial nephrectomy (TPRAPN). Methods: With this Vattikuti Collective Quality Initiative (VCQI) database, study propensity scores were calculated according to the surgical access (TPRAPN and RPRAPN) for the following independent variables, i.e., age, sex, side of the surgery, RENAL nephrometry scores (RNS), estimated glomerular filtration rate (eGFR) and serum creatinine. The study's primary outcome was the comparison of trifecta between the two groups. Results: In this study, 309 patients who underwent RPRAPN were matched with 309 patients who underwent TPRAPN. The two groups matched well for age, sex, tumor side, polar location of the tumor, RNS, preoperative creatinine and eGFR. Operative time and warm ischemia time were significantly shorter with RPRAPN. Intraoperative blood loss and need for blood transfusion were lower with RPRAPN. There was a significantly higher number of intraoperative complications with RPRAPN. However, there was no difference in the two groups for postoperative complications. Trifecta outcomes were better with RPRAPN (70.2% vs. 53%, p < 0.0001) compared to TPRAPN. We noted no significant change in overall results when controlled for tumor location (anteriorly or posteriorly). The surgical approach, tumor size and RNS were identified as independent predictors of trifecta on multivariate analysis. Conclusion: RPRAPN is associated with superior perioperative outcomes in well-selected patients compared to TPRAPN. However, the data for the retroperitoneal approach were contributed by a few centers with greater experience with this technique, thus limiting the generalizability of the results of this study.
AB - Objective: To compare perioperative outcomes following retroperitoneal robot-assisted partial nephrectomy (RPRAPN) and transperitoneal robot-assisted partial nephrectomy (TPRAPN). Methods: With this Vattikuti Collective Quality Initiative (VCQI) database, study propensity scores were calculated according to the surgical access (TPRAPN and RPRAPN) for the following independent variables, i.e., age, sex, side of the surgery, RENAL nephrometry scores (RNS), estimated glomerular filtration rate (eGFR) and serum creatinine. The study's primary outcome was the comparison of trifecta between the two groups. Results: In this study, 309 patients who underwent RPRAPN were matched with 309 patients who underwent TPRAPN. The two groups matched well for age, sex, tumor side, polar location of the tumor, RNS, preoperative creatinine and eGFR. Operative time and warm ischemia time were significantly shorter with RPRAPN. Intraoperative blood loss and need for blood transfusion were lower with RPRAPN. There was a significantly higher number of intraoperative complications with RPRAPN. However, there was no difference in the two groups for postoperative complications. Trifecta outcomes were better with RPRAPN (70.2% vs. 53%, p < 0.0001) compared to TPRAPN. We noted no significant change in overall results when controlled for tumor location (anteriorly or posteriorly). The surgical approach, tumor size and RNS were identified as independent predictors of trifecta on multivariate analysis. Conclusion: RPRAPN is associated with superior perioperative outcomes in well-selected patients compared to TPRAPN. However, the data for the retroperitoneal approach were contributed by a few centers with greater experience with this technique, thus limiting the generalizability of the results of this study.
KW - Partial nephrectomy
KW - Propensity matching
KW - RAPN
KW - Retroperitoneal
UR - http://www.scopus.com/inward/record.url?scp=85134486732&partnerID=8YFLogxK
U2 - 10.1007/s00345-022-04101-4
DO - 10.1007/s00345-022-04101-4
M3 - Article
AN - SCOPUS:85134486732
SN - 0724-4983
VL - 40
SP - 2283
EP - 2291
JO - World Journal of Urology
JF - World Journal of Urology
IS - 9
ER -