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

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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 & 3 more Francesco Porpiglia, Levent Turkeri, Gagan Gautam

Original languageEnglish
Pages (from-to)2283-2291
Number of pages9
JournalWorld Journal of Urology
Volume40
Issue number9
Early online date22 Jul 2022
DOIs
Accepted/In press7 Jul 2022
E-pub ahead of print22 Jul 2022
PublishedSep 2022

Bibliographical note

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.

King's Authors

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.

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