Retroperitoneal versus transperitoneal robot-assisted partial nephrectomy: Comparison in a multi-institutional setting.

Document Type

Article

Publication Date

7-24-2018

Publication Title

Urology

Keywords

Kidney neoplasms-renal cell carcinoma; Kidney neoplasms-surgery; Nephrectomy-methods; Propensity scores; Retroperitoneal space-surgery; Robotic surgical procedures

Abstract

OBJECTIVES: To evaluate retroperitoneal robot-assisted partial nephrectomy (RAPN) against transperitoneal approach in a multi-institutional prospective database, after accounting for potential selection bias that may affect this comparison.

PATIENTS AND METHODS: Post-hoc analysis of the prospective arm of the Vattikuti Collective Quality Initiative database from 2014-2018. Six hundred and ninety consecutive patients underwent RAPN by 22 surgeons at 14 centers in nine countries. Patients who had surgery at centers not performing retroperitoneal approach (n=197) were excluded. Inverse probability of treatment weighting was done to account for potential selection bias by adjusting for age, gender, body mass index, comorbidities, side of surgery, location/size/complexity of tumor, renal function, American Society of Anesthesiologists score, and year of surgery. Operative and perioperative outcomes were compared between weighted transperitoneal and retroperitoneal cohorts.

RESULTS: 99 patients underwent retroperitoneal RAPN; 394 underwent transperitoneal RAPN. Hospital stay in days-median 3.0 (Interquartile range [IQR] 2.0-4.0) transperitoneal vs. 1.0 (1.0-3.0) retroperitoneal; p

CONCLUSIONS: In a multi-institutional setting, both retroperitoneal and transperitoneal approach to RAPN have comparable operative and perioperative outcomes, except for shorter hospital stay with the retroperitoneal approach.

Clinical Institute

Kidney & Diabetes

Department

Nephrology

Department

Surgery

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