Comparison of robot-assisted and laparoscopic partial nephrectomy for renal hilar tumors: results from a tertiary referral center.

OBJECTIVE To compare perioperative, functional and oncological outcomes between robot-assisted partial nephrectomy (RAPN) and laparoscopic partial nephrectomy (LPN) for renal hilar tumors. METHODS We retrospectively reviewed patients who underwent minimally invasive partial nephrectomy for renal hilar tumors at our institution between January 2014 and August 2018. The entire cohort was divided into two groups according to surgical approach: RAPN and LPN group. Perioperative, functional and oncological outcomes of two groups were collected and compared. RESULTS A total of 116 patients with renal hilar tumors were identified, including 52 patients underwent RAPN and 64 patients underwent LPN, respectively. Demographic baseline characteristics were similar in two groups. There were no differences between RAPN and LPN group for operative time, transfusion rate, conversion rate, surgical margin, perioperative complication, and hospital stay. Compared with LPN group, RAPN group was associated with significant less estimated blood loss (100 vs 150 mL; P<0.001), shorter warm ischemia time (20.3 vs 24.5 min; P=0.001) and higher direct cost (P<0.001). Percentage of estimated glomerular filtration rate change at 6 months after surgery was lower in RAPN group than LPN group (10.4% vs 15.2%; P=0.020). No significant difference was observed between two groups in term of oncological outcomes. CONCLUSIONS For hilar tumors, both RAPN and LPN were safe and feasible surgical treatment. RAPN might be assoicated with superior perioperative outcomes (less estimated blood loss and shorter warm ischemia time) and better postoperative renal functional preservation than LPN. RAPN might be the preferred option when condition permits for renal hilar tumors.