ROBOT-ASSISTED VERSUS LAPAROSCOPIC PARTIAL NEPHRECTOMY. A MULTICENTER MATCHED-PAIR ANALYSIS

Aim of the study Only few studies compared the results of the two main alternatives of minimally invasive treatment of renal cell carcinoma (RCC), providing conflicting results regarding which technique provides more frequently the maximum success from a surgical perspective. Our aim was to compare the Trifecta outcome in a large multicenter matched series of patients treated with laparoscopic partial nephrectomy (LPN) or robotic- assisted partial nephrectomy (RPN) for cT1 RCC. Materials and methods Patients of the RPN arm, treated from Sept 2008 to Sept 2010, were extracted from a multicenter, international database including cases done in four high volume centers Patients of the LPN arm, treated between Jan 2009 and Dec 2012, were extracted from the REgistry of COnservative Renal surgery database(RECORd) promoted by LUNA foundation of the Italian Society of Urology. We undertook a matched-pair analysis for patients age, tumor size, longitudinal location (polar vs mid pole) and exophytic rate (≥50% exophytic vs others), with a 1:1 ratio with respect to the surgical approach, including 306 patients in both LPN and RPN groups. Perioperative outcomes were compared with univariate analysis, and a correlation analysis assessed clinical variables associated with the Trifecta outcome, defined as warm ischemia time (WIT) Results Groups were comparable in gender distribution and preoperative renal function, as well as the matched variables. In RPN vs. LPN group, no significant differences resulted regarding operative time, perioperative complications (9.2% and 11.1%,p=0.43), reoperation rate for Clavien grade≥3 complications (2% vs. 2.6%,p=0.97) positive surgical margin rate (4.2%vs.2.5%;p=0.22) and pathological and short-term functional results. The pedicle clamping was used significantly more often in the RPN group(87.9% vs. 49%,p Conclusions The current multicenter analysis reveals that, in experienced hands, the trifecta can be achieved in ¾ of patients both with LPN and RPN without significant differences. Additional studies are needed to investigate this issue further.