A comparative analysis of pre-operative factors, intra-operative events and post-operative outcomes assessing transperitoneal and retroperitoneal approaches for robotic partial nephrectomy in T1 renal cancer: a multicenter international experience.

The aim of our study is to compare and assess the correlation of preoperative factors, intraoperative events and post-operative outcomes of robot assisted transperitoneal (RATP) and robot assisted retroperitoneal (RARP) partial nephrectomy (PN) in T1 renal cancer. Data from 2609 patients during the period of 10 years who underwent either RATP or RARP partial nephrectomies was retrospectively analyzed. We compared preoperative factors (age, BMI, tumour size/stage, PADUA score, preoperative eGFR, history of previous abdominal and ipsilateral surgery), intraoperative events: operative time (OT), warm ischemia time (WIT), estimated blood loss (EBL), and post-operative outcomes: complications, eGFR, positive surgical margins (PSM), and death due to disease (DOD) or due to other causes (DOC) and survival rates. Patients in the RATP-PN group were younger, PADUA score was similar in both groups-9, tumour size was smaller in RARP-PN. OT (103 min. vs 86 min) and WIT (23 min vs 10 min) were longer in RATP-PN (p < 0.001). EBL was higher in RATP-PN and in T1b tumours (p = 0). At 40 months follow-up, eGFR was same in both groups. There were slightly more Clavien-Dindo ≥3a complications in RARP-PN cohort. T1b tumours showed higher EBL than T1a tumours (p = 0). At end of follow-up, in RP group, 79.86% were alive, 3.87% DOD and 16.86% DOC; in TP cohorts, at 40 months of follow-up, 82.68% were alive, 2.66% DOD and 14.66% DOC. There is no relation between preoperative demographic or tumour factors on post operative complications. Tumour size and PADUA score had no effect on EBL Advanced age is a strong predictor for DOC in both T1a and T1b tumours; high PADUA score is associated with DOD in T1a tumours but not in T1b tumours.