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Laparoscopic vs robot‐assisted partial nephrectomy for renal tumours of >4 cm: a propensity score‐based analysis
Author(s) -
Gu Liangyou,
Ma Xin,
Wang Baojun,
Xie Yongpeng,
Li Xintao,
Gao Yu,
Lyu Xiangjun,
Huang Qingbo,
Fan Yang,
Yao Yuanxin,
Wang Yunpeng,
Li Hongzhao,
Zhang Xu
Publication year - 2018
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.14386
Subject(s) - medicine , propensity score matching , nephrectomy , perioperative , renal function , surgery , urology , blood loss , kidney
Objectives To compare perioperative data, functional and oncological outcomes between laparoscopic partial nephrectomy ( LPN ) and robot‐assisted partial nephrectomy ( RAPN ) for renal tumours of >4 cm. Patients and Methods We retrospectively reviewed patients who underwent either LPN or RAPN between 2008 and 2015. To adjust for potential baseline confounders, propensity score matching (1:1) was performed. Perioperative data, functional and oncological outcomes were reviewed. Disease‐free survival, cancer‐specific survival and overall survival were analysed using Kaplan–Meier survival curves with log‐rank tests. Results In all, 197 patients underwent LPN and 96 underwent RAPN during the study period. After matching, there was no significant difference between the groups for baseline characteristics. Within the matched cohort, the LPN group was associated with significantly higher estimated blood loss (150 vs 100 mL; P < 0.001), longer renal artery clamp time (25 vs 20 min; P < 0.001), longer postoperative hospital stay (7 vs 5 days; P < 0.001), and lower rate of Margin, Ischaemia, and Complications ( MIC ) achievement (30.2% vs 46.9%; P = 0.018). The postoperative percentage of estimated glomerular filtration rate decline was higher in the LPN group (11.3% vs 5.5%; P = 0.018). Complication and surgical conversion outcomes were similar between LPN and RAPN . There was no significant difference in oncological outcomes between the groups. Conclusions For patients with renal tumours of >4 cm, RAPN is more favourable than LPN in terms of perioperative outcomes (i.e. estimated blood loss, renal artery clamp time and postoperative hospital stay) and early renal functional preservation.