OPEN VERSUS ROBOTIC-ASSISTED PARTIAL NEPHRECTOMY: MULTICENTER COMPARATIVE STUDY OF SURGICAL RESULTS AND COMPLICATIONS (AGILE GROUP)

Aim of the study To compare surgical and perioperative outcomes of open partial ne- phrectomy (OPN) with those of robotic assisted partial nephrectomy (RAPN). Materials and methods This is 2-year multicentric study derived from a prospective da- tabase promoted by AGILE group, who included all patients treated awith OPN or RAPN for renal cell carcinoma between January 2010 and December 2011 at six Italian urologic centers. All clinical vari- ables, including tumor nephrometry (PADUA score) and laboratory analyses, were recorded. Surgical results and complications, oc- curred within 30 days after surgery and stratified with Clavien sys- tem, and pathological data were registered. All significant differ- ences in each variable in OPN versus RAPN group were assessed with univariate analysis. Independent predictors of surgical compli- cations were evaluated with multivariate analysis. Results Overall, 198 and 104 patients were enrolled in the OPN and RAPN group, respectively. Distribution of gender, age, body mass index, ASA score, tumor nephrometry (PADUA score) and preoperative serum haemoglobin and creatinine, was not significantly differ- ent in the two groups. Charlson comorbility index was significantly higher in RAPN group while clinical tumor diameter was higher and imperative surgical indication was more frequent in OPN group. Pedicle clamping was used in 48% and 62.5% of OPN and RAPN group, but in 11.5% (12/104) of RAPN a selective arterial clamping was used. In RAPN group, one case needed conversion to OPN. At univariate analysis, there was no significant difference in warm ischemia time, intraoperative complications, postoperative medical complications, delta of serum creatinine, positive surgical margins and benign tumor rates. The operative time resulted significantly higher in RAPN group. Discussion Further studies are needed to evaluate the functional and oncologi- cal results of RAPN as in this analysis, from an oncological view- point, we were able to evaluate only the surgical margin rate. Conclusions In our analysis the robotic approach clearly improved the safety of conservative surgery in terms of postoperative complication and the reintervention rates. RAPN had longer operative time but a not sig- nificantly different warm ischemia time compared to OPN.