Surgical and Functional Outcomes on Omitting Cortical Renorrhaphy During Robot-Assisted Versus Laparoscopic Partial Nephrectomy: A Match-Paired Analysis

Objectives: To assess surgical and functional outcomes in comparison of cortical renorrhaphy omitting, robot-assisted partial nephrectomy (CRO-RAPN), and laparoscopic partial nephrectomy (CRO-LPN). Methods Between July 2012 and June 2020, patients with localized clinical T1-2 renal masses who underwent CRO-RAPN or CRO-LPN were reviewed. The outcomes of the CRO-RAPN and CRO-LPN groups were compared using propensity score matching. Trifecta was defined as negative surgical margin, less than 25 minutes of warm ischemic time, and no complications of Clavien-Dindo grade III or more until three months postoperatively. Preservation rate of the estimated glomerular filtration rate (eGFR) was evaluated at six months postoperatively. Results A total of 291 patients, including 210 patients who underwent CRO-RAPN and 81 patients who underwent CRO-LPN, were included, and matched pairs of 150 patients were analyzed. The CRO-RAPN group was associated with a significantly shorter warm ischemic time (13 min vs 20 min, P < 0.001), shorter total operation time (162 min vs 212 min, P < 0.001), less estimated blood loss (40 mL vs 119 mL, P = 0.002), lower incidence of overall complications (3% vs 16%, P = 0.001), higher preservation rate of eGFR at six months postoperatively (93% vs 89%, P = 0.003), and higher trifecta achievement rate (84% vs 64%, P = 0.004) than the CRO-LPN group. Conclusions CRO-RAPN contributes to a shorter warm ischemic time, less blood loss, fewer complications, and preservation of renal function and makes it feasible to achieve a higher rate of trifecta compared to CRO-LPN.