Session: MP47: Kidney Cancer: Localized: Surgical Therapy II
MP47-13: A Comparative Analysis of Robot-assisted Retroperitoneoscopic Partial nephrectomy (RARPN) for Anterior vs Posterior Renal tumors: A Propensity Score Matched Analysis in a Multi-Institutional Cohort
Introduction: Robot-assisted retroperitoneoscopic partial nephrectomy (RARPN) has emerged as the approach of choice for posterior renal tumors. However, the role of RARPN for anterior tumors in cases of prior abdominal surgeries and anticipation of intraabdominal adhesions has not been studied. This study aims to evaluate the perioperative characteristics and surgical outcomes in patients who underwent RARPN for anterior vs posterior renal tumors in a multi-institutional cohort. Methods: A retrospective analysis of prospectively maintained database of 12 institutions for patients undergoing RARPN from 2006 to 2022 was performed. Patients undergoing RARPN were classified as Group A for anterior renal tumors and Group B and for posterior renal tumors. Propensity score matched analysis was adopted. Perioperative outcomes were compared between the two groups. Trifecta outcomes were defined as negative surgical margins, ischemia time < 25 min and no perioperative complications. Results: 469 patients who underwent RARPN were included with 39 patients in Group A vs 430 patients in Group B. The average age 60.3(12.2) years and baseline eGFR was 81.8(66.3-97.1) ml/min/1.73m2 did not differ between cohorts. After propensity score matching the average tumor size (2.6cm) and tumor complexity as assessed using the R.E.N.A.L. score, were similar in both groups (p=0.882). In terms of perioperative outcomes, the operative time (119 min v 117 min, p=0.736), and the warm ischemia time (17 min v 17 min, p=0.992) were similar among the two groups. However, the median hospital stay for Group A was longer as compared to Group B [1.8 vs 1.3 days, p=0.002]. The margin positivity rate was 10% in Group A vs. 5% in Group B (p=0.488). In terms of major complications, 7.3% of patients in Group B had Clavien-Dindo grade III or higher complications as compared to 0% in Group A. The median eGFR on follow-up at 1 month (67.3 in Group A vs 70.5ml/min/1.73m2 in Group B, p=0.151) and 3 months (69.1 in Group A vs 73.6ml/min/1.73m2, p=0.924) were similar amongst the two groups. The Trifecta achievement was equivalent in both groups (77% in Group A vs 76% in Group B). Conclusions: RARPN is feasible for anterior renal tumors and yields similar perioperative outcomes as posterior renal tumors. Hence, RARPN should be considered for anterior tumors in patients with prior abdominal surgeries or anticipated extensive adhesions. SOURCE OF Funding: n/a
