Comparison of perioperative outcomes following transperitoneal versus retroperitoneal robot-assisted partial nephrectomy: a propensity-matched analysis of VCQI database

Gopal Sharma; Milap Shah; Puneet Ahluwalia; Prokar Dasgupta; Benjamin J. Challacombe; Mahendra Bhandari; Rajesh Ahlawat; Sudhir Rawal; Nicolo M. Buffi; Ananthkrishnan Sivaraman; James R. Porter; Craig Rogers; Alexandre Mottrie; Ronney Abaza; Khoon Ho Rha; Daniel Moon; Thyavihally B. Yuvaraja; Dipen J. Parekh; Umberto Capitanio; Kris K. Maes; Francesco Porpiglia; Levent Turkeri; Gagan Gautam

doi:10.1007/s00345-022-04101-4

Comparison of perioperative outcomes following transperitoneal versus retroperitoneal robot-assisted partial nephrectomy: a propensity-matched analysis of VCQI database

Gopal Sharma
, Milap Shah
, Puneet Ahluwalia
, Prokar Dasgupta
, Benjamin J. Challacombe
, Mahendra Bhandari
, Rajesh Ahlawat
, Sudhir Rawal
, Nicolo M. Buffi
, Ananthkrishnan Sivaraman
, James R. Porter
, Craig Rogers
, Alexandre Mottrie
, Ronney Abaza
, Khoon Ho Rha
, Daniel Moon
, Thyavihally B. Yuvaraja
, Dipen J. Parekh
, Umberto Capitanio
, Kris K. Maes

Francesco Porpiglia, Levent Turkeri, Gagan Gautam^*

^*Corresponding author for this work

Max Institute of Cancer Care
Vattikuti Foundation
The Medicity Hospital
Rajiv Gandhi Cancer Institute and Research Centre
Istituto Clinico Humanitas
Chennai Urology and Robotics Institute
Swedish Medical Center, Seattle
Henry Ford Health
ORSI Academy
Mount Carmel Health System
Yonsei University
University of Melbourne
Kokilaben Dhirubhai Ambani Hospital
University of Miami Health System
IRCCS Ospedale San Raffaele
Hospital da Luz
San Luigi Gonzaga Hospital
Aydınlar University

Research output: Contribution to journal › Article › peer-review

22 Citations (Scopus)

86 Downloads (Pure)

Abstract

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.

Original language	English
Pages (from-to)	2283-2291
Number of pages	9
Journal	World Journal of Urology
Volume	40
Issue number	9
Early online date	22 Jul 2022
DOIs	https://doi.org/10.1007/s00345-022-04101-4
Publication status	Published - Sept 2022

Keywords

Partial nephrectomy
Propensity matching
RAPN
Retroperitoneal

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Comparison of perioperative outcomes_SHARMA_Accepted7July2022_GREEN AAMAccepted author manuscript, 570 KB

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Sharma, G., Shah, M., Ahluwalia, P., Dasgupta, P., Challacombe, B. J., Bhandari, M., Ahlawat, R., Rawal, S., Buffi, N. M., Sivaraman, A., Porter, J. R., Rogers, C., Mottrie, A., Abaza, R., Rha, K. H., Moon, D., Yuvaraja, T. B., Parekh, D. J., Capitanio, U., ... Gautam, G. (2022). Comparison of perioperative outcomes following transperitoneal versus retroperitoneal robot-assisted partial nephrectomy: a propensity-matched analysis of VCQI database. World Journal of Urology, 40(9), 2283-2291. https://doi.org/10.1007/s00345-022-04101-4

@article{6929ab0fad0f48ccb63414b25c6bb769,

title = "Comparison of perioperative outcomes following transperitoneal versus retroperitoneal robot-assisted partial nephrectomy: a propensity-matched analysis of VCQI database",

abstract = "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.",

keywords = "Partial nephrectomy, Propensity matching, RAPN, Retroperitoneal",

author = "Gopal Sharma and Milap Shah and Puneet Ahluwalia and Prokar Dasgupta and Challacombe, \{Benjamin J.\} and Mahendra Bhandari and Rajesh Ahlawat and Sudhir Rawal and Buffi, \{Nicolo M.\} and Ananthkrishnan Sivaraman and Porter, \{James R.\} and Craig Rogers and Alexandre Mottrie and Ronney Abaza and Rha, \{Khoon Ho\} and Daniel Moon and Yuvaraja, \{Thyavihally B.\} and Parekh, \{Dipen J.\} and Umberto Capitanio and Maes, \{Kris K.\} and Francesco Porpiglia and Levent Turkeri and Gagan Gautam",

note = "Funding Information: Authors would like to thank Vattikuti Foundation for providing data. Publisher Copyright: {\textcopyright} 2022, The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.",

year = "2022",

month = sep,

doi = "10.1007/s00345-022-04101-4",

language = "English",

volume = "40",

pages = "2283--2291",

journal = "World Journal of Urology",

issn = "0724-4983",

publisher = "Springer Science and Business Media Deutschland GmbH",

number = "9",

}

Sharma, G, Shah, M, Ahluwalia, P, Dasgupta, P , Challacombe, BJ, Bhandari, M, Ahlawat, R, Rawal, S, Buffi, NM, Sivaraman, A, Porter, JR, Rogers, C, Mottrie, A, Abaza, R, Rha, KH, Moon, D, Yuvaraja, TB, Parekh, DJ, Capitanio, U, Maes, KK, Porpiglia, F, Turkeri, L & Gautam, G 2022, 'Comparison of perioperative outcomes following transperitoneal versus retroperitoneal robot-assisted partial nephrectomy: a propensity-matched analysis of VCQI database', World Journal of Urology, vol. 40, no. 9, pp. 2283-2291. https://doi.org/10.1007/s00345-022-04101-4

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 - https://www.scopus.com/pages/publications/85134486732

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 -

Comparison of perioperative outcomes following transperitoneal versus retroperitoneal robot-assisted partial nephrectomy: a propensity-matched analysis of VCQI database

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Keywords

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