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Propensity‐score matched analysis comparing robot‐assisted with laparoscopic partial nephrectomy
Author(s) -
Wu Zhenjie,
Li Mingmin,
Song Shangqing,
Ye Huamao,
Yang Qing,
Liu Bing,
Cai Chen,
Yang Bo,
Xiao Liang,
Chen Qi,
Lü Chen,
Gao Xu,
Xu Chuanliang,
Gao Xiaofeng,
Hou Jianguo,
Wang Linhui,
Sun Yinghao
Publication year - 2015
Publication title -
bju international
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.773
H-Index - 148
eISSN - 1464-410X
pISSN - 1464-4096
DOI - 10.1111/bju.12774
Subject(s) - medicine , propensity score matching , nephrectomy , confidence interval , renal function , odds ratio , kidney disease , urology , surgery , logistic regression , kidney
Objectives To compare the peri‐operative and early renal functional outcomes of robot‐assisted partial nephrectomy ( RAPN ) and laparoscopic partial nephrectomy ( LPN ) for kidney tumours. Materials and Methods A total of 237 patients fulfilling the selection criteria were included, of whom 146 and 91 patients were treated with LPN and RAPN , respectively. To adjust for potential baseline confounders, propensity‐score matching was performed. A favourable outcome was defined as a warm ischaemia time ( WIT ) of ≤20 min, negative surgical margins, no surgical conversion, no C lavien ≥3 complications and no postoperative chronic kidney disease ( CKD ) upstaging. Descriptive statistics and multivariable logistic regression analyses were performed before and after propensity‐score matching. Results Within the propensity‐score‐matched cohort, the RAPN group was associated with significantly lower estimated blood loss ( EBL ; 156 vs 198 mL, mean difference [ MD ] = −42; P = 0.025), a shorter WIT (22.8 vs 31 min, MD = −8.2; P < 0.001) and a higher proportion of malignant lesions (88.4 vs 67.5%; odds ratio [ OR ]: 2.6; 95% confidence interval [ CI ]: 1.2–5.67; P = 0.023). With regard to early renal functional outcomes, the mean last estimated glomerular filtration rate was 95.8 and 89.4 mL/min per 1.73 m 2 ( MD = 6.4; P = 0.01), with a mean ± sd percentage change of −4.8 ± 17.9 and −12.2 ± 16.6 ( MD = 7.4; P = 0.018) in the RAPN and LPN groups, respectively. The intra‐operative complication rate was significantly lower in the RAPN group (1.3 vs 11.7%; OR 0.1, 95% CI 0.01–0.81; P = 0.018). On multivariable analysis, surgical approach ( RAPN vs LPN , OR 5.457, 95% CI 2.075–14.346; P = 0.001), Charlson Comorbidity Index ( OR 0.223; 95% CI 0.062–0.811; P = 0.023), diameter‐axial‐polar score ( OR 0.488, 95% CI 0.329–0.723; P < 0.001) and preoperative CKD stage ( OR 3.189, 95% CI 1.204–8.446; P = 0.020) were found to be independent predictors of obtaining a favourable outcome. Conclusions After adjusting for potential treatment selection biases, RAPN was found to be superior to LPN for peri‐operative outcomes ( EBL , WIT and intra‐operative complications) and early renal functional preservation.