Robot-Assisted versus Open Partial Nephrectomy: Propensity-Matched Perioperative Outcomes and Oncologic Safety up to 5 Years

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However, high-quality comparative data remain limited. This study aimed to compare intraoperative, perioperative, and oncologic outcomes of RAPN versus OPN using propensity score-matched cohort. Methods : In this retrospective, single-centre study, 386 patients underwent PN between January 2020 and December 2024. After applying exclusion criteria and propensity-score matching, 152 OPN cases were matched with 125 RAPN. Matching variables included age, Charlson Comorbidity Index, RENAL and PADUA scores, cT stage, and location. Primary endpoint was intraoperative complication rate. Secondary endpoints included estimated blood loss (EBL), operative time, warm-ischemia time, length of hospital stay (LOS), postoperative complications rate (Clavien-Dindo classification), and 5-year oncologic outcomes (overall-survival [OS], cancer-specific survival [CSS], and recurrence-free survival [RFS]). Results : RAPN was associated with lower intraoperative complication rate compared to OPN (2% vs. 10%, p = 0.003). RAPN resulted in lower EBL (200 mL vs. 300 mL, p = 0.001), shorter operative time (147 vs. 170 min, p = 0.001), and reduced LOS (median 6 days, p = 0.001). Postoperative complications were less frequent with RAPN (14% vs. 25%, p = 0.01), with no significant differences in severe complications or positive surgical margins. Five-year OS, CSS, and RFS were similar between groups. Conclusions : RAPN provides significant perioperative advantages over OPN without compromising oncologic safety at 5 years. These findings support broader adoption of RAPN in selected patients. Multicenter studies are warranted to assess cost-effectiveness, long-term functional outcomes, and generalizability. Kidney cancer robot-assisted partial nephrectomy open nephrectomy intraoperative complication Figures Figure 1 1. Introduction Renal cell carcinoma (RCC) is a commonly diagnosed malignancy in Europe, with approximately 100,000 new cases reported annually, affecting both men and women across the region [ 1 , 2 ]. Surgical excision remains the primary curative treatment for localized RCC, with partial nephrectomy (PN) preferred as a nephron-sparing option whenever suitable. PN may be performed using a traditional open technique (OPN) or through minimally invasive methods, such as robotic-assisted partial nephrectomy (RAPN). Current international guidelines advise that the choice of surgical approach should be based on the surgeon’s proficiency and experience [ 3 , 4 ], as there is a lack of high-quality randomized trials definitively favoring one technique over the other. Nevertheless, the widespread adoption of RAPN has accelerated in recent years [ 5 ], underscoring the pressing need for randomized studies to validate this trend. Although OPN is a well-established and standardized operation, it is associated with considerable morbidity, including postoperative complications like hernias and flank bulges, which can affect up to 50% of patients and may have a lasting impact on quality of life [ 6 , 7 ]. The shift toward minimally invasive PN is largely driven by its potential benefits, including reduced postoperative pain, lower incidence of wound-related complications, and shorter hospitalization, all contributing to a faster recovery process [ 8 ]. While some randomized clinical trials (RCTs) have demonstrated that robotic-assisted surgery offers advantages over open surgery in terms of estimated blood loss (EBL), length of hospital stay (LOS), and preservation of renal function [ 9 – 12 ], direct comparative data between RAPN and OPN remain limited. Therefore, the objective of this study is to evaluate and compare intraoperative, perioperative, and oncologic outcomes of open versus robotic-assisted partial nephrectomy using a propensity score-matched analysis. 2. Materials and methods 2.1 Study design and participants All patients treated with partial nephrectomy for a renal mass between January 2020 and December 2024, recorded in our institution’s prospectively maintained dataset, were included in this single-center, retrospective, comparative study. Institutional review board approval was obtained (ID 7520). Each enrolled patient underwent a preoperative contrast-enhanced CT scan or contrast-enhanced MRI scan (depending on serum creatinine levels) of the abdomen and thorax within three months prior to surgery to define the best surgical treatment. No biopsies were performed before surgery. Eligibility for robotic or open surgery was determined by the proficiency of the operating surgeon in conjunction with department scheduling. All patients signed written informed consent. Three experienced surgeons performed OPN (M.R., N.F., M.R.), while three experienced surgeons performed RAPN (B.R., E.S., A.T.). 2.2 Eligibility Criteria Inclusion Criteria Inclusion criteria were age at surgery ≥ 18 years, indication for partial nephrectomy and availability of preoperative data (abdominal CT scan or MRI). Exclusion Criteria The following patients were excluded: patients with prior history of ipsilateral renal cancer or recurrence after partial nephrectomy. 2.3 Sample size calculation Sample size calculation was performed based on the primary outcome of intraoperative complication rates, assuming from the literature a 10–15% for OPN and 2–6% for RAPN. With a two-sided α of 0.05 and 80% power, a minimum of 120 patients per group was required to detect a significant difference. 2.4 Demographic data included Preoperative data collection included variables such as clinical tumor size, laterality, anatomical location, proximity to the collecting system, clinical T stage, baseline serum creatinine, and estimated glomerular filtration rate (eGFR), calculated using the Modification of Diet in Renal Disease (MDRD) formula. Tumor complexity was also assessed using both the RENAL and PADUA scoring systems. Intraoperative parameters comprised the type of surgical approach (robotic or open), total operative time, method of renal pedicle control (standard clamping, selective clamping, or no clamping), warm ischemia duration, tumor excision technique (pure enucleation or enucleoresection), estimated blood loss (EBL), presence of positive surgical margins (PSMs), length of hospital stay (LOS), and occurrence of intraoperative or 90-day postoperative complications. Postoperative follow-up evaluations included histopathological findings, hospital readmissions, complications occurring within 90 days after surgery, as well as assessment of patient survival and cancer recurrence during routine outpatient visits scheduled every six months. 2.5 Outcomes Primary outcomes were intraoperative complications rate. Secondary outcomes included EBL, operating time, warm ischemia time, LOS, PSMs, postoperative complications, which were classified using the Clavien-Dindo system [ 13 ], overall survival (OS), cancer specific survival (CSS), and recurrence free survival (RFS) at 5 years. 2.6 Statistical analysis and propensity score matching Data distribution was assessed using both the Shapiro-Wilk test and visual inspection through graphical methods. Continuous variables were summarized as mean and standard deviation (SD). For normally distributed data, comparisons between groups were made using the Student’s t-test, while the Mann-Whitney U test was employed for non-normally distributed variables. Categorical variables were analyzed using the Pearson chi-squared (χ²) test. Differences in survival outcomes between treatment groups were evaluated with a stratified log-rank test, and hazard ratios (HRs) with corresponding 95% confidence intervals (CIs) were calculated using a stratified Cox proportional hazards regression model. To minimize selection bias and account for confounding in the comparison between open and robotic surgical approaches, propensity score matching (PSM) was applied. Propensity scores were estimated via logistic regression, with the surgical approach set as the dependent variable. Predictors included in the model were: age at the time of surgery, age-adjusted Charlson Comorbidity Index, categorized PADUA and RENAL scores, clinical T stage, and tumor location. These covariates were selected based on clinical relevance and their potential influence on both treatment assignment and clinical outcomes. Matching was performed using a nearest-neighbor algorithm without replacement and a caliper width of 0.1. Covariate balance between groups before and after matching was evaluated using standardized mean differences and visual tools. Post-matching, continuous outcomes were compared using the Mann-Whitney U test, while categorical outcomes were analyzed using Pearson’s chi-squared test. The average treatment effect on the treated (ATT) was calculated to assess the impact of surgical approach on key outcomes. All statistical analyses were performed using STATA version 19 (StataCorp LLC), with statistical significance defined as a two-tailed p-value of less than 0.05. 3. Results A total of 449 patients underwent partial nephrectomy during the study period. Of these, 63 were excluded due to missing preoperative data or inadequate follow-up. The final analysis included 386 patients, comprising 172 who underwent OPN and 214 who underwent RAPN. Following propensity score matching, 152 patients in the open group were matched to 125 patients in the robotic group (Table 1 ). Matching was performed using a logistic regression model based on age at surgery, Charlson Comorbidity Index, PADUA and RENAL scores, clinical T stage, and tumor location ( Supplementary materials ). Post-matching comparison demonstrated a balanced distribution of baseline characteristics across groups, with no statistically significant differences in age, BMI, CCI, or nephrometrics scores, confirming an adequate balance between cohorts. Intraoperative complications were significantly more frequent in the open group than in the robotic group (Table 2 ). Before matching, complications occurred in 9% of open procedures compared to only 0.9% in robotic surgeries (p = 0.001). This difference remained significant even after matching, with 10% of patients in the open group experiencing complications versus 2% in the robotic group (p = 0.003). Length of hospital stay (LOS) was also longer among patients undergoing open surgery. After matching, the median LOS was 6 days (IQR 6–7) in the open group and 6 days (IQR 5–7) in the robotic group, with the difference reaching statistical significance (p = 0.001). Among secondary outcomes, estimated blood loss was substantially higher in the open group compared to the robotic group. After matching, the median blood loss was 300 mL (IQR 200–600) in the open group versus 200 mL (IQR 100–300) in the robotic group, which was statistically significant (p = 0.001). Operative time was also longer in open procedures (170 vs. 147 minutes, p = 0.001). In contrast, warm ischemia time showed no significant difference between the two approaches following matching (p = 0.12). Postoperative complications were more frequent in the open group, with overall complications occurring in 25% of patients compared to 14% in the robotic group (p = 0.01). However, no significant differences were observed in the rate of severe complications, defined as Clavien-Dindo grade ≥ III (2% vs. 1%, p = 0.25), nor in the incidence of positive surgical margins (PSM) (3% vs. 6%, p = 0.23). Oncological outcomes at 5 years, including OS, CSS, and RFS, were similar between the two surgical approaches. The Kaplan-Meier analysis showed no statistically significant difference in OS (log-rank p = 0.68), CSS (log-rank p = 0.68), or RFS (log-rank p = 0.67) between patients undergoing open or robotic partial nephrectomy. The number of patients at risk at each time point is displayed in the corresponding Kaplan-Meier curves (Fig. 1 ). Table 1 Baseline Demographic Characteristics of Patients Undergoing Open and Robotic Surgery Before and After Propensity Score Matching Variable Before matching After matching Open, n = 172 Robotic, n = 214 p-value Open, n = 152 Robotic, n = 125 p-value Age (years) median (IQR) 64 (54–72) 64 (55–71) 0.55 65 (54–72) 65 (56–71) 0.64 BMI (kg/m 2 ), median (IQR) 26 (23–25) 26 (23–28) 0.90 26 (23–25) 26 (23–28 0.90 CCI, median (IQR) 4 (2–5) 4 (2–6) 0.33 4 (2–5) 4 (2–5) 0.75 Smoke 0.96 0.95 Current 41 (25) 52 (25) 38 (26) 32 (26) Former 17 (10) 22 (10) 15 (10) 11 (9) Previous abdominal surgery, n (%) 78 (48) 103 (50) 0.67 71 (48) 61 (50) 0.72 Preoperative creatinine, median (IQR) 0.9 (0.7-1) 0.9 (0.7-1) 0.01 0.9 (0.7-1) 0.8 (0.7-1) 0.02 PADUA, median (IQR) 8 (6–10) 7 (6–8) 0.001 7 (6–9) 7 (6–9) 0.43 PADUA, n (%) 0.001 0.37 Low 85 (49) 130 (61) 82 (54) 69 (55) Moderate 41 (24) 66 (31) 39 (26) 38 (30) High 46 (27) 18 (8) 31 (20) 18 (14) RENAL, median (IQR) 8 (7–9) 7 (6–8) 0.001 8 (7–9) 8 (7–8) 0.21 RENAL, n (%) 0.001 0.34 Low 32 (19) 70 (33) 29 (19) 20 (16) Moderate 100 (58) 127 (59) 96 (63) 89 (71) High 40 (23) 17 (8) 27 (18) 16 (13) Size, median (IQR) 4 (3–5) 2.5 (2-3.5) 0.001 4 (3–5) 3 (2–4) 0.001 Clinical stage, n (%) 0.001 0.05 cT1a 85 (50) 163 (80) 84 (55) 87 (69) cT1b 40 (26) 22 (11) 39 (26) 20 (16) cT2 6 (4) 2 (1) 6 (4) 1 (1) cT3 39 (22) 17 (8) 23 (15) 17 (13) Side, n (%) 0.27 0.91 Right 80 (42) 112 (58) 70 (46) 58 (46) Left 92 (58) 102 (42) 80 (53) 66 (53) Tumor location, n (%) 0.03 0.29 Anterior 82 (40) 125 (60) 69 (45) 49 (39) Posterior 90 (50) 89 (50) 83 (54) 76 (61) Extirpative technique, n (%) 0.29 0.69 Pure enucleation 12 (7) 11 (5) 11 (7) 6 (5) Enucleoresection 154 (90) 200 (93) 137 (90) 116 (93) Wegde resection 6 (4) 3 (1) 4 (3) 3 (2) Tumor growth pattern, n (%) 0.06 0.82 > 50% exophytic 33 (19) 55 (26) 32 (21) 26 (21) < 50% exophytic 127 (74) 153 (72) 110 (72) 93 (74) Endophytic 12 (7) 6 (3) 10 (7) 6 (5) Note: BMI: body mass index; CCI: Charlson Comorbidity Index. Table 2 Comparison of Perioperative and Pathological Outcomes Between Open and Robotic Groups Before and After Propensity Score Matching Variable Before matching After matching Open, n = 172 Robotic, n = 214 p-value Open, n = 152 Robotic, n = 125 p-value Intraoperative Complications, n (%) 16 (9) 2 (0.9) 0.001 15 (10) 2 (2) 0.003 Postoperative Complications, n (%) 46 (27) 37 (17) 0.02 38 (25) 17 (14) 0.01 Postoperative Complication Clavien-Dindo ≥ III, n (%) 4 (2) 2 (1) 0.10 3 (2) 2 (1) 0.25 Operative time, median (IQR) 168 (145–204) 139 (115–168) 0.001 170 (144–204) 147 (122–179) 0.001 WIT (min), median (IQR) 10 (7–12) 10 (8–13) 0.19 10 (7–12) 10 (10–13) 0.12 EBL (ml), median (IQR) 300 (200–600) 150 (100–250) 0.001 300 (200–600) 200 (100–300) 0.001 LOS (days), median (IQR) 6 (6–7) 6 (5–6) 0.001 6 (6–7) 6 (5–7) 0.001 Follow up (months), median (IQR) 33 (18–49) 22 (6–30) 0.001 30 (15–46) 20 (4–26) 0.001 Creatinine at 12 months (mg/dL), median (IQR) 1 (0.8–1.2) 0.9 (0.7-1) 0.14 1 (0.7–1.1) 0.8 (0.6-1) 0.22 Histology, n (%) 0.01 0.06 Benign 28 (17) 50 (23) 28 (18) 39 (28) Clear cell 94 (54) 100 (47) 88 (54) 62 (45) Papillary 18 (10) 33 (15) 17 (10) 17 (10) Chromophobe 23 (13) 11 (5) 22 (13) 8 (7) Angiomyolipoma 3 (2) 13 (6) 2 (1) 6 (5) Other 6 (4) 6 (4) 5 (4) 5 (5) Pathological stage, n (%) 0.08 0.22 pT1a 138 (80) 191 (89) 126 (83) 110 (88) pT1b 25 (14) 13 (6) 20 (14) 7 (6) pT2 3 (2) 5 (2) 2 (2) 4 (2) pT3 6 (3) 5 (2) 4 (3) 3 (2) PSM, n (%) 5 (3) 13 (6) 0.14 5 (3) 8 (6) 0.23 Local recurrence, n (%) 4 (2) 1 (1) 0.10 4 (3) 0 (0) 0.06 Note: WIT: warm ischemia time; EBL: estimated blood loss; PSM: positive surgical margins. 4. Discussion In this single‑center, propensity‑matched cohort, RAPN was associated with fewer intraoperative and overall postoperative complications, lower estimated blood loss, shorter operative time, and shorter length of stay compared with OPN. Oncologic outcomes were comparable between approaches at the longest available follow‑up, with no differences in overall, cancer‑specific, or recurrence‑free survival. Together, these data suggest that the perioperative efficiency of RAPN does not compromise intermediate‑term oncologic control. The lower complication rates observed in the RAPN group likely reflect the enhanced visualization, dexterity, and precision afforded by robotic platforms. These technical advantages translate clinically into less tissue trauma and more accurate vascular control, which in turn reduce bleeding and facilitate faster recovery [ 14 ]. Analyzing data of other surgical specialties, robotic surgical approach is strongly related to lower complication rates, so our results can be defined in line with the literature [ 15 , 16 ]. The reduction in overall postoperative complication rates could lead to the spread of robot-assisted surgical approach for more challenging, bigger, and more complex renal masses, setting the line to higher postoperative standards. The shorter LOS and the reduced EBL not only benefit patients but may also lessen the burden on healthcare systems by decreasing postoperative resource utilization. Indeed, a population-based analysis demonstrated that although RAPN incurs higher initial costs, these may be offset by fewer complications and readmissions [ 17 ]. Conversely, other studies have reported greater total expenditures for robotic procedures, indicating that the overall cost-effectiveness of RAPN remains to be fully elucidated [ 18 , 19 ]. Notably, the reduced rate of intra- and postoperative complications of the robotic approach has led to an increase of its use in frail patients, who particularly benefit from the use of RAPN instead of OPN, as supported by data across various surgical specialties [ 20 , 21 ]. Operative time is another relevant point. Surprisingly, in our study robotic surgery showed faster operative time than OPN. Probably proficiency acquired by both our surgeons and scrub nurses plays a pivotal role. Fast docking time and technical surgical skills can lead to a relevant reduction in work-time [ 22 ]. In addition, practice can improve operative time after each procedure [ 23 ]. Moreover, differences in terms of operative time could lay on risk factors: prior abdominal surgery and tumor size [ 24 ]. However, data in the literature about this topic reveal a longer operative time in robotic-assisted surgeries, it could be related to different docking techniques or the use of robot-assisted surgery for more complex procedures [ 25 , 26 ]. More studies are needed, having consequences in hospitals’ economies. Oncological safety was confirmed by equivalent rates of positive surgical margins (PSM) and comparable survival outcomes. This finding aligns with emerging evidence endorsing RAPN even for anatomically complex renal tumors, including those with elevated RENAL or PADUA scores [ 27 – 30 ]. Accurate tumor classification is therefore critical for anticipating surgical challenges and selecting the optimal approach [ 31 ]. To this end, the introduction of three-dimensional virtual modeling enhances preoperative planning by offering superior spatial resolution compared with conventional two-dimensional imaging, thereby improving risk stratification and facilitating nephron-sparing decisions [ 32 ]. Future trials incorporating refined complexity metrics may further delineate the contexts in which RAPN offers maximal advantage over OPN. Our results have both clinical and systemic implications. Clinically, RAPN appears to deliver a safer perioperative course and equivalent long-term cancer control, which may translate into expedited convalescence and reduced morbidity. From a health-system perspective, these advantages could yield cost savings and greater efficiency as robotic technology becomes increasingly prevalent. This study has limitations. Key strengths include granular perioperative data, use of nephrometry scores, and efforts to mitigate selection bias via propensity methods. Limitations include the retrospective single‑center design, residual post‑matching imbalances, absence of detailed renal functional endpoints, and follow‑up immaturity for definitive 5‑year conclusions. These limitations notwithstanding, the consistent perioperative advantages without apparent oncologic compromise support the use of RAPN in appropriately selected patients. 5. Conclusions RAPN is associated with lower perioperative morbidity and resource utilization compared with OPN, with comparable oncologic outcomes at the longest available follow‑up. Enhanced reporting of renal functional preservation, rigorous balance diagnostics, and sensitivity analyses will further substantiate these findings and inform patient‑centered surgical decision‑making. Declarations Conflicts of Interest The authors declare no conflict of interest. Funding This research received no external funding. 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Amparore D, Piramide F, Verri P, et al (2025) Nephrometry Scores Based on Three-dimensional Virtual Models Improve the Accuracy of Predicting Postoperative Complications After Robotic Partial Nephrectomy: Results from a Collaborative ERUS Validation Study. Eur Urol Open Sci 74:11–20. Additional Declarations No competing interests reported. Supplementary Files Supplymentarymaterials.docx Cite Share Download PDF Status: Published Journal Publication published 27 Dec, 2025 Read the published version in International Urology and Nephrology → Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-7474859","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":518282771,"identity":"7c7ee88f-e19d-4a31-802a-7fe121154b5d","order_by":0,"name":"Filippo Gavi","email":"data:image/png;base64,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","orcid":"","institution":"Fondazione Policlinico A. 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(B) cancer specific survival in the study population (log-rank p = 0.68); (C) recurrence-free survival in the study population (log-rank p = 0.67); HR=hazard ratio.\u003c/p\u003e","description":"","filename":"floatimage1.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-7474859/v1/aeb1e8fec8678a909d8cff9f.jpeg"},{"id":99172374,"identity":"7fc0dd5a-fe91-4866-a6ef-bc15411a7481","added_by":"auto","created_at":"2025-12-29 16:08:32","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1322067,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7474859/v1/8eda8469-ae43-4f44-80fb-ef595ea34d97.pdf"},{"id":92012820,"identity":"3e34378a-d98b-46cd-a6df-40c8cb79a445","added_by":"auto","created_at":"2025-09-23 15:56:38","extension":"docx","order_by":0,"title":"","display":"","copyAsset":false,"role":"supplement","size":198171,"visible":true,"origin":"","legend":"","description":"","filename":"Supplymentarymaterials.docx","url":"https://assets-eu.researchsquare.com/files/rs-7474859/v1/2d895d42ad683caedba0a6cd.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"Robot-Assisted versus Open Partial Nephrectomy: Propensity-Matched Perioperative Outcomes and Oncologic Safety up to 5 Years","fulltext":[{"header":"1. Introduction","content":"\u003cp\u003eRenal cell carcinoma (RCC) is a commonly diagnosed malignancy in Europe, with approximately 100,000 new cases reported annually, affecting both men and women across the region [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. Surgical excision remains the primary curative treatment for localized RCC, with partial nephrectomy (PN) preferred as a nephron-sparing option whenever suitable. PN may be performed using a traditional open technique (OPN) or through minimally invasive methods, such as robotic-assisted partial nephrectomy (RAPN). Current international guidelines advise that the choice of surgical approach should be based on the surgeon\u0026rsquo;s proficiency and experience [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e], as there is a lack of high-quality randomized trials definitively favoring one technique over the other. Nevertheless, the widespread adoption of RAPN has accelerated in recent years [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e], underscoring the pressing need for randomized studies to validate this trend.\u003c/p\u003e\u003cp\u003eAlthough OPN is a well-established and standardized operation, it is associated with considerable morbidity, including postoperative complications like hernias and flank bulges, which can affect up to 50% of patients and may have a lasting impact on quality of life [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. The shift toward minimally invasive PN is largely driven by its potential benefits, including reduced postoperative pain, lower incidence of wound-related complications, and shorter hospitalization, all contributing to a faster recovery process [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. While some randomized clinical trials (RCTs) have demonstrated that robotic-assisted surgery offers advantages over open surgery in terms of estimated blood loss (EBL), length of hospital stay (LOS), and preservation of renal function [\u003cspan additionalcitationids=\"CR10 CR11\" citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e], direct comparative data between RAPN and OPN remain limited. Therefore, the objective of this study is to evaluate and compare intraoperative, perioperative, and oncologic outcomes of open versus robotic-assisted partial nephrectomy using a propensity score-matched analysis.\u003c/p\u003e"},{"header":"2. Materials and methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\u003ch2\u003e2.1 Study design and participants\u003c/h2\u003e\u003cp\u003eAll patients treated with partial nephrectomy for a renal mass between January 2020 and December 2024, recorded in our institution\u0026rsquo;s prospectively maintained dataset, were included in this single-center, retrospective, comparative study. Institutional review board approval was obtained (ID 7520). Each enrolled patient underwent a preoperative contrast-enhanced CT scan or contrast-enhanced MRI scan (depending on serum creatinine levels) of the abdomen and thorax within three months prior to surgery to define the best surgical treatment. No biopsies were performed before surgery. Eligibility for robotic or open surgery was determined by the proficiency of the operating surgeon in conjunction with department scheduling. All patients signed written informed consent. Three experienced surgeons performed OPN (M.R., N.F., M.R.), while three experienced surgeons performed RAPN (B.R., E.S., A.T.).\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec4\" class=\"Section2\"\u003e\u003ch2\u003e2.2 Eligibility Criteria\u003c/h2\u003e\u003cp\u003eInclusion Criteria\u003c/p\u003e\u003cp\u003eInclusion criteria were age at surgery\u0026thinsp;\u0026ge;\u0026thinsp;18 years, indication for partial nephrectomy and availability of preoperative data (abdominal CT scan or MRI).\u003c/p\u003e\u003cp\u003eExclusion Criteria\u003c/p\u003e\u003cp\u003eThe following patients were excluded: patients with prior history of ipsilateral renal cancer or recurrence after partial nephrectomy.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec5\" class=\"Section2\"\u003e\u003ch2\u003e2.3 Sample size calculation\u003c/h2\u003e\u003cp\u003eSample size calculation was performed based on the primary outcome of intraoperative complication rates, assuming from the literature a 10\u0026ndash;15% for OPN and 2\u0026ndash;6% for RAPN. With a two-sided α of 0.05 and 80% power, a minimum of 120 patients per group was required to detect a significant difference.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec6\" class=\"Section2\"\u003e\u003ch2\u003e2.4 Demographic data included\u003c/h2\u003e\u003cp\u003ePreoperative data collection included variables such as clinical tumor size, laterality, anatomical location, proximity to the collecting system, clinical T stage, baseline serum creatinine, and estimated glomerular filtration rate (eGFR), calculated using the Modification of Diet in Renal Disease (MDRD) formula. Tumor complexity was also assessed using both the RENAL and PADUA scoring systems. Intraoperative parameters comprised the type of surgical approach (robotic or open), total operative time, method of renal pedicle control (standard clamping, selective clamping, or no clamping), warm ischemia duration, tumor excision technique (pure enucleation or enucleoresection), estimated blood loss (EBL), presence of positive surgical margins (PSMs), length of hospital stay (LOS), and occurrence of intraoperative or 90-day postoperative complications. Postoperative follow-up evaluations included histopathological findings, hospital readmissions, complications occurring within 90 days after surgery, as well as assessment of patient survival and cancer recurrence during routine outpatient visits scheduled every six months.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec7\" class=\"Section2\"\u003e\u003ch2\u003e2.5 Outcomes\u003c/h2\u003e\u003cp\u003ePrimary outcomes were intraoperative complications rate. Secondary outcomes included EBL, operating time, warm ischemia time, LOS, PSMs, postoperative complications, which were classified using the Clavien-Dindo system [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e], overall survival (OS), cancer specific survival (CSS), and recurrence free survival (RFS) at 5 years.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e\u003ch2\u003e2.6 Statistical analysis and propensity score matching\u003c/h2\u003e\u003cp\u003eData distribution was assessed using both the Shapiro-Wilk test and visual inspection through graphical methods. Continuous variables were summarized as mean and standard deviation (SD). For normally distributed data, comparisons between groups were made using the Student\u0026rsquo;s t-test, while the Mann-Whitney U test was employed for non-normally distributed variables. Categorical variables were analyzed using the Pearson chi-squared (χ\u0026sup2;) test. Differences in survival outcomes between treatment groups were evaluated with a stratified log-rank test, and hazard ratios (HRs) with corresponding 95% confidence intervals (CIs) were calculated using a stratified Cox proportional hazards regression model.\u003c/p\u003e\u003cp\u003eTo minimize selection bias and account for confounding in the comparison between open and robotic surgical approaches, propensity score matching (PSM) was applied. Propensity scores were estimated via logistic regression, with the surgical approach set as the dependent variable. Predictors included in the model were: age at the time of surgery, age-adjusted Charlson Comorbidity Index, categorized PADUA and RENAL scores, clinical T stage, and tumor location. These covariates were selected based on clinical relevance and their potential influence on both treatment assignment and clinical outcomes. Matching was performed using a nearest-neighbor algorithm without replacement and a caliper width of 0.1. Covariate balance between groups before and after matching was evaluated using standardized mean differences and visual tools.\u003c/p\u003e\u003cp\u003ePost-matching, continuous outcomes were compared using the Mann-Whitney U test, while categorical outcomes were analyzed using Pearson\u0026rsquo;s chi-squared test. The average treatment effect on the treated (ATT) was calculated to assess the impact of surgical approach on key outcomes. All statistical analyses were performed using STATA version 19 (StataCorp LLC), with statistical significance defined as a two-tailed p-value of less than 0.05.\u003c/p\u003e\u003c/div\u003e"},{"header":"3. Results","content":"\u003cp\u003eA total of 449 patients underwent partial nephrectomy during the study period. Of these, 63 were excluded due to missing preoperative data or inadequate follow-up. The final analysis included 386 patients, comprising 172 who underwent OPN and 214 who underwent RAPN. Following propensity score matching, 152 patients in the open group were matched to 125 patients in the robotic group (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). Matching was performed using a logistic regression model based on age at surgery, Charlson Comorbidity Index, PADUA and RENAL scores, clinical T stage, and tumor location (\u003cem\u003eSupplementary materials\u003c/em\u003e). Post-matching comparison demonstrated a balanced distribution of baseline characteristics across groups, with no statistically significant differences in age, BMI, CCI, or nephrometrics scores, confirming an adequate balance between cohorts. Intraoperative complications were significantly more frequent in the open group than in the robotic group (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). Before matching, complications occurred in 9% of open procedures compared to only 0.9% in robotic surgeries (p\u0026thinsp;=\u0026thinsp;0.001). This difference remained significant even after matching, with 10% of patients in the open group experiencing complications versus 2% in the robotic group (p\u0026thinsp;=\u0026thinsp;0.003). Length of hospital stay (LOS) was also longer among patients undergoing open surgery. After matching, the median LOS was 6 days (IQR 6\u0026ndash;7) in the open group and 6 days (IQR 5\u0026ndash;7) in the robotic group, with the difference reaching statistical significance (p\u0026thinsp;=\u0026thinsp;0.001). Among secondary outcomes, estimated blood loss was substantially higher in the open group compared to the robotic group. After matching, the median blood loss was 300 mL (IQR 200\u0026ndash;600) in the open group versus 200 mL (IQR 100\u0026ndash;300) in the robotic group, which was statistically significant (p\u0026thinsp;=\u0026thinsp;0.001). Operative time was also longer in open procedures (170 vs. 147 minutes, p\u0026thinsp;=\u0026thinsp;0.001). In contrast, warm ischemia time showed no significant difference between the two approaches following matching (p\u0026thinsp;=\u0026thinsp;0.12). Postoperative complications were more frequent in the open group, with overall complications occurring in 25% of patients compared to 14% in the robotic group (p\u0026thinsp;=\u0026thinsp;0.01). However, no significant differences were observed in the rate of severe complications, defined as Clavien-Dindo grade\u0026thinsp;\u0026ge;\u0026thinsp;III (2% vs. 1%, p\u0026thinsp;=\u0026thinsp;0.25), nor in the incidence of positive surgical margins (PSM) (3% vs. 6%, p\u0026thinsp;=\u0026thinsp;0.23).\u003c/p\u003e\u003cp\u003eOncological outcomes at 5 years, including OS, CSS, and RFS, were similar between the two surgical approaches. The Kaplan-Meier analysis showed no statistically significant difference in OS (log-rank p\u0026thinsp;=\u0026thinsp;0.68), CSS (log-rank p\u0026thinsp;=\u0026thinsp;0.68), or RFS (log-rank p\u0026thinsp;=\u0026thinsp;0.67) between patients undergoing open or robotic partial nephrectomy. The number of patients at risk at each time point is displayed in the corresponding Kaplan-Meier curves (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eBaseline Demographic Characteristics of Patients Undergoing Open and Robotic Surgery Before and After Propensity Score Matching\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"7\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eVariable\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003eBefore matching\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e\u003cp\u003eAfter matching\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eOpen, n\u0026thinsp;=\u0026thinsp;172\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eRobotic, n\u0026thinsp;=\u0026thinsp;214\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003ep-value\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eOpen,\u003c/p\u003e\u003cp\u003en\u0026thinsp;=\u0026thinsp;152\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eRobotic,\u003c/p\u003e\u003cp\u003en\u0026thinsp;=\u0026thinsp;125\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003ep-value\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAge (years) median (IQR)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e64 (54\u0026ndash;72)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e64 (55\u0026ndash;71)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.55\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e65 (54\u0026ndash;72)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e65 (56\u0026ndash;71)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.64\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eBMI (kg/m\u003csup\u003e2\u003c/sup\u003e), median (IQR)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e26 (23\u0026ndash;25)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e26 (23\u0026ndash;28)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.90\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e26 (23\u0026ndash;25)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e26 (23\u0026ndash;28\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.90\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCCI, median (IQR)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e4 (2\u0026ndash;5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e4 (2\u0026ndash;6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.33\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e4 (2\u0026ndash;5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e4 (2\u0026ndash;5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.75\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSmoke\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.96\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.95\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCurrent\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e41 (25)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e52 (25)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e38 (26)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e32 (26)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFormer\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e17 (10)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e22 (10)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e15 (10)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e11 (9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePrevious abdominal surgery, n (%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e78 (48)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e103 (50)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.67\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e71 (48)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e61 (50)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.72\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePreoperative creatinine, median (IQR)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.9 (0.7-1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.9 (0.7-1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.01\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.9 (0.7-1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.8 (0.7-1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.02\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePADUA, median (IQR)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e8 (6\u0026ndash;10)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e7 (6\u0026ndash;8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e7 (6\u0026ndash;9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e7 (6\u0026ndash;9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.43\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePADUA, n (%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.37\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eLow\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e85 (49)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e130 (61)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e82 (54)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e69 (55)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eModerate\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e41 (24)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e66 (31)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e39 (26)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e38 (30)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHigh\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e46 (27)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e18 (8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e31 (20)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e18 (14)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eRENAL, median (IQR)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e8 (7\u0026ndash;9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e7 (6\u0026ndash;8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e8 (7\u0026ndash;9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e8 (7\u0026ndash;8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.21\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eRENAL, n (%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.34\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eLow\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e32 (19)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e70 (33)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e29 (19)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e20 (16)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eModerate\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e100 (58)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e127 (59)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e96 (63)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e89 (71)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHigh\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e40 (23)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e17 (8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e27 (18)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e16 (13)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSize, median (IQR)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e4 (3\u0026ndash;5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e2.5 (2-3.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e4 (3\u0026ndash;5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e3 (2\u0026ndash;4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eClinical stage, n (%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.05\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ecT1a\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e85 (50)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e163 (80)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e84 (55)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e87 (69)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ecT1b\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e40 (26)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e22 (11)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e39 (26)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e20 (16)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ecT2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e6 (4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e2 (1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e6 (4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e1 (1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ecT3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e39 (22)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e17 (8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e23 (15)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e17 (13)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSide, n (%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.27\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.91\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eRight\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e80 (42)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e112 (58)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e70 (46)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e58 (46)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eLeft\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e92 (58)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e102 (42)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e80 (53)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e66 (53)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTumor location, n (%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.03\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.29\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAnterior\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e82 (40)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e125 (60)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e69 (45)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e49 (39)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePosterior\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e90 (50)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e89 (50)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e83 (54)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e76 (61)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eExtirpative technique, n (%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.29\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.69\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePure enucleation\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e12 (7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e11 (5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e11 (7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e6 (5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eEnucleoresection\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e154 (90)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e200 (93)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e137 (90)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e116 (93)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eWegde resection\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e6 (4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e3 (1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e4 (3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e3 (2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTumor growth pattern, n (%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.06\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.82\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u0026gt;\u0026thinsp;50% exophytic\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e33 (19)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e55 (26)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e32 (21)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e26 (21)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;50% exophytic\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e127 (74)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e153 (72)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e110 (72)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e93 (74)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eEndophytic\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e12 (7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e6 (3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e10 (7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e6 (5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"7\" nameend=\"c7\" namest=\"c1\"\u003e\u003cp\u003e\u003cem\u003eNote: BMI: body mass index; CCI: Charlson Comorbidity Index.\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eComparison of Perioperative and Pathological Outcomes Between Open and Robotic Groups Before and After Propensity Score Matching\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"7\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eVariable\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003eBefore matching\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e\u003cp\u003eAfter matching\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eOpen, n\u0026thinsp;=\u0026thinsp;172\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eRobotic, n\u0026thinsp;=\u0026thinsp;214\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003ep-value\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eOpen,\u003c/p\u003e\u003cp\u003en\u0026thinsp;=\u0026thinsp;152\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eRobotic,\u003c/p\u003e\u003cp\u003en\u0026thinsp;=\u0026thinsp;125\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003ep-value\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eIntraoperative Complications, n (%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e16 (9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e2 (0.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e15 (10)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e2 (2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.003\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePostoperative Complications, n (%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e46 (27)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e37 (17)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.02\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e38 (25)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e17 (14)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.01\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePostoperative Complication Clavien-Dindo\u0026thinsp;\u0026ge;\u0026thinsp;III, n (%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e4 (2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e2 (1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.10\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e3 (2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e2 (1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.25\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eOperative time, median (IQR)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e168 (145\u0026ndash;204)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e139 (115\u0026ndash;168)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e170 (144\u0026ndash;204)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e147 (122\u0026ndash;179)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eWIT (min), median (IQR)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e10 (7\u0026ndash;12)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e10 (8\u0026ndash;13)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.19\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e10 (7\u0026ndash;12)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e10 (10\u0026ndash;13)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.12\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eEBL (ml), median (IQR)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e300 (200\u0026ndash;600)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e150 (100\u0026ndash;250)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e300 (200\u0026ndash;600)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e200 (100\u0026ndash;300)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eLOS (days), median (IQR)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e6 (6\u0026ndash;7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e6 (5\u0026ndash;6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e6 (6\u0026ndash;7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e6 (5\u0026ndash;7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFollow up (months), median (IQR)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e33 (18\u0026ndash;49)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e22 (6\u0026ndash;30)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e30 (15\u0026ndash;46)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e20 (4\u0026ndash;26)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCreatinine at 12 months (mg/dL), median (IQR)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1 (0.8\u0026ndash;1.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.9 (0.7-1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.14\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1 (0.7\u0026ndash;1.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.8 (0.6-1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.22\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHistology, n (%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.01\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.06\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eBenign\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e28 (17)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e50 (23)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e28 (18)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e39 (28)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eClear cell\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e94 (54)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e100 (47)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e88 (54)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e62 (45)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePapillary\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e18 (10)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e33 (15)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e17 (10)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e17 (10)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eChromophobe\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e23 (13)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e11 (5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e22 (13)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e8 (7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAngiomyolipoma\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e3 (2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e13 (6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e2 (1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e6 (5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eOther\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e6 (4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e6 (4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e5 (4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e5 (5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePathological stage, n (%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.08\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.22\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003epT1a\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e138 (80)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e191 (89)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e126 (83)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e110 (88)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003epT1b\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e25 (14)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e13 (6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e20 (14)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e7 (6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003epT2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e3 (2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e5 (2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e2 (2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e4 (2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003epT3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e6 (3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e5 (2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e4 (3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e3 (2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePSM, n (%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e5 (3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e13 (6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.14\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e5 (3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e8 (6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.23\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eLocal recurrence, n (%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e4 (2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1 (1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.10\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e4 (3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0 (0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.06\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"7\" nameend=\"c7\" namest=\"c1\"\u003e\u003cp\u003e\u003cem\u003eNote: WIT: warm ischemia time; EBL: estimated blood loss; PSM: positive surgical margins.\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e\u003c/p\u003e"},{"header":"4. Discussion","content":"\u003cp\u003eIn this single‑center, propensity‑matched cohort, RAPN was associated with fewer intraoperative and overall postoperative complications, lower estimated blood loss, shorter operative time, and shorter length of stay compared with OPN. Oncologic outcomes were comparable between approaches at the longest available follow‑up, with no differences in overall, cancer‑specific, or recurrence‑free survival. Together, these data suggest that the perioperative efficiency of RAPN does not compromise intermediate‑term oncologic control.\u003c/p\u003e\u003cp\u003eThe lower complication rates observed in the RAPN group likely reflect the enhanced visualization, dexterity, and precision afforded by robotic platforms. These technical advantages translate clinically into less tissue trauma and more accurate vascular control, which in turn reduce bleeding and facilitate faster recovery [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. Analyzing data of other surgical specialties, robotic surgical approach is strongly related to lower complication rates, so our results can be defined in line with the literature [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. The reduction in overall postoperative complication rates could lead to the spread of robot-assisted surgical approach for more challenging, bigger, and more complex renal masses, setting the line to higher postoperative standards.\u003c/p\u003e\u003cp\u003eThe shorter LOS and the reduced EBL not only benefit patients but may also lessen the burden on healthcare systems by decreasing postoperative resource utilization. Indeed, a population-based analysis demonstrated that although RAPN incurs higher initial costs, these may be offset by fewer complications and readmissions [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. Conversely, other studies have reported greater total expenditures for robotic procedures, indicating that the overall cost-effectiveness of RAPN remains to be fully elucidated [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e, \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. Notably, the reduced rate of intra- and postoperative complications of the robotic approach has led to an increase of its use in frail patients, who particularly benefit from the use of RAPN instead of OPN, as supported by data across various surgical specialties [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e, \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eOperative time is another relevant point. Surprisingly, in our study robotic surgery showed faster operative time than OPN. Probably proficiency acquired by both our surgeons and scrub nurses plays a pivotal role. Fast docking time and technical surgical skills can lead to a relevant reduction in work-time [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]. In addition, practice can improve operative time after each procedure [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]. Moreover, differences in terms of operative time could lay on risk factors: prior abdominal surgery and tumor size [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]. However, data in the literature about this topic reveal a longer operative time in robotic-assisted surgeries, it could be related to different docking techniques or the use of robot-assisted surgery for more complex procedures [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e, \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e]. More studies are needed, having consequences in hospitals\u0026rsquo; economies.\u003c/p\u003e\u003cp\u003eOncological safety was confirmed by equivalent rates of positive surgical margins (PSM) and comparable survival outcomes. This finding aligns with emerging evidence endorsing RAPN even for anatomically complex renal tumors, including those with elevated RENAL or PADUA scores [\u003cspan additionalcitationids=\"CR28 CR29\" citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e]. Accurate tumor classification is therefore critical for anticipating surgical challenges and selecting the optimal approach [\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e]. To this end, the introduction of three-dimensional virtual modeling enhances preoperative planning by offering superior spatial resolution compared with conventional two-dimensional imaging, thereby improving risk stratification and facilitating nephron-sparing decisions [\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e]. Future trials incorporating refined complexity metrics may further delineate the contexts in which RAPN offers maximal advantage over OPN.\u003c/p\u003e\u003cp\u003eOur results have both clinical and systemic implications. Clinically, RAPN appears to deliver a safer perioperative course and equivalent long-term cancer control, which may translate into expedited convalescence and reduced morbidity. From a health-system perspective, these advantages could yield cost savings and greater efficiency as robotic technology becomes increasingly prevalent.\u003c/p\u003e\u003cp\u003eThis study has limitations. Key strengths include granular perioperative data, use of nephrometry scores, and efforts to mitigate selection bias via propensity methods. Limitations include the retrospective single‑center design, residual post‑matching imbalances, absence of detailed renal functional endpoints, and follow‑up immaturity for definitive 5‑year conclusions. These limitations notwithstanding, the consistent perioperative advantages without apparent oncologic compromise support the use of RAPN in appropriately selected patients.\u003c/p\u003e"},{"header":"5. Conclusions","content":"\u003cp\u003eRAPN is associated with lower perioperative morbidity and resource utilization compared with OPN, with comparable oncologic outcomes at the longest available follow‑up. Enhanced reporting of renal functional preservation, rigorous balance diagnostics, and sensitivity analyses will further substantiate these findings and inform patient‑centered surgical decision‑making.\u003c/p\u003e"},{"header":"Declarations","content":"\u003ch2\u003eConflicts of Interest\u003c/h2\u003e\u003cp\u003eThe authors declare no conflict of interest.\u003c/p\u003e\u003ch2\u003eFunding\u003c/h2\u003e\u003cp\u003eThis research received no external funding.\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eAll authors whose names appear on the submission made substantial contributions to the conception or design of the work; or the acquisition, analysis, or interpretation of data; or the creation of new software used in the work; drafted the work or revised it critically for important intellectual content; approved the version to be published; and agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eFerlay J, Colombet M, Soerjomataram I, et al (2018) Cancer incidence and mortality patterns in Europe: Estimates for 40 countries and 25 major cancers in 2018. 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Int Braz J Urol Off J Braz Soc Urol 51(5):e20250203.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eJeong IG, Khandwala YS, Kim JH, et al (2017) Association of Robotic-Assisted vs Laparoscopic Radical Nephrectomy With Perioperative Outcomes and Health Care Costs, 2003 to 2015. JAMA 318(16):1561.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eKriegmair MC, Younsi N, Hiller K, et al (2021) Single- vs multiple‐layer wound closure for flank incisions: results of a prospective, randomised, double‐blinded multicentre study. BJU Int 127(1):64\u0026ndash;70.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eChatterjee S, Nam R, Fleshner N, Klotz L (2004) Permanent flank bulge is a consequence of flank incision for radical nephrectomy in one half of patients. 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Ann Surg 240(2):205\u0026ndash;13.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eCrocerossa F, Carbonara U, Cantiello F, et al (2021) Robot-assisted Radical Nephrectomy: A Systematic Review and Meta-analysis of Comparative Studies. Eur Urol 80(4):428\u0026ndash;439.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eLenfant L, Canlorbe G, Belghiti J, et al (2023) Robotic-assisted benign hysterectomy compared with laparoscopic, vaginal, and open surgery: a systematic review and meta-analysis. J Robot Surg 17(6):2647\u0026ndash;2662.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eBergengren O, Belozerov A, Bill-Axelson A, et al (2023) Short term outcomes after robot assisted and open cystectomy - A nation-wide population-based study. Eur J Surg Oncol 49(4):868\u0026ndash;874.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eSighinolfi MC, Panio E, Calcagnile T, et al (2025) Radical Cystectomy with Elective Indication to Cutaneous Ureterostomy: Single-Center Comparative Analysis Between Open and Robotic Surgery in Frail Patients. Int Braz J Urol 51(3):e20240556.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eRosiello G, Palumbo C, Deuker M, et al (2021) Partial nephrectomy in frail patients: Benefits of robot-assisted surgery. Surg Oncol 38:101588.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eCamp C, O\u0026rsquo;Hara J, Hughes D, Adshead J (2018) Short-term Outcomes and Costs Following Partial Nephrectomy in England: A Population-based Study. Eur Urol Focus 4(4):579\u0026ndash;85.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eBuse S, Hach CE, Klumpen P, et al (2018) Cost-effectiveness analysis of robot‐assisted vs. open partial nephrectomy. Int J Med Robot 14(4):e1920.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eGrobet-Jeandin E, Pinar U, Parra J, et al (2022) Medico‐economic impact of onco‐urological robot‐assisted minimally invasive surgery in a high‐volume centre. Int J Med Robot 18(6):e2462.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eOlsen RG, Bjerrum F, Konge L, et al (2024) How experienced robotic nurses adapt to the Hugo\u0026trade; RAS system. J Robot Surg 18(1):114.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eAwad MA, Buzalewski J, Anderson C, et al (2020) Robotic Inguinal Hernia Repair Outcomes: Operative Time and Cost Analysis. JSLS 24(4):e2020.00058.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eKrishnan NK, Zappia J, Calaway AC, Nagle RT, Sundaram CP, Boris RS (2022) Identifying Preoperative Predictors of Operative Time and Their Impact on Outcomes in Robot-Assisted Partial Nephrectomy. J Endourol 36(1):71\u0026ndash;76.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eCella L, Basile G, Moretto S, et al (2024) Robotic assisted vs open radical cystectomy: an updated systematic review and meta-analysis. J Robot Surg 18(1):277.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eMachairas N, Papaconstantinou D, Tsilimigras DI, et al (2019) Comparison between robotic and open liver resection: a systematic review and meta-analysis of short-term outcomes. Updates Surg 71(1):39\u0026ndash;48.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003ePorpiglia F, Mari A, Bertolo R, et al (2016) Partial Nephrectomy in Clinical T1b Renal Tumors: Multicenter Comparative Study of Open, Laparoscopic and Robot-assisted Approach (the RECORd Project). 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BJU Int 114(6):903\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eAutorino R, Khalifeh A, Laydner H, et al (2013) Repeat robot-assisted partial nephrectomy (RAPN): feasibility and early outcomes. BJU Int 111(5):767\u0026ndash;72.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eGavi F, Sighinolfi MC, Pallotta G, et al (2025) Multiomics in Renal Cell Carcinoma: Current Landscape and Future Directions for Precision Medicine. Curr Urol Rep 26(1):44.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eAmparore D, Piramide F, Verri P, et al (2025) Nephrometry Scores Based on Three-dimensional Virtual Models Improve the Accuracy of Predicting Postoperative Complications After Robotic Partial Nephrectomy: Results from a Collaborative ERUS Validation Study. Eur Urol Open Sci 74:11\u0026ndash;20.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Kidney cancer, robot-assisted partial nephrectomy, open nephrectomy, intraoperative complication","lastPublishedDoi":"10.21203/rs.3.rs-7474859/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7474859/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cb\u003ePurpose\u003c/b\u003e:\u003c/p\u003e\u003cp\u003ePartial nephrectomy (PN) is preferred treatment for localized renal cell carcinoma (RCC), with shift toward robotic-assisted PN (RAPN) over open PN (OPN). However, high-quality comparative data remain limited. This study aimed to compare intraoperative, perioperative, and oncologic outcomes of RAPN versus OPN using propensity score-matched cohort.\u003c/p\u003e\u003cp\u003e\u003cb\u003eMethods\u003c/b\u003e:\u003c/p\u003e\u003cp\u003eIn this retrospective, single-centre study, 386 patients underwent PN between January 2020 and December 2024. After applying exclusion criteria and propensity-score matching, 152 OPN cases were matched with 125 RAPN. Matching variables included age, Charlson Comorbidity Index, RENAL and PADUA scores, cT stage, and location. Primary endpoint was intraoperative complication rate. Secondary endpoints included estimated blood loss (EBL), operative time, warm-ischemia time, length of hospital stay (LOS), postoperative complications rate (Clavien-Dindo classification), and 5-year oncologic outcomes (overall-survival [OS], cancer-specific survival [CSS], and recurrence-free survival [RFS]).\u003c/p\u003e\u003cp\u003e\u003cb\u003eResults\u003c/b\u003e:\u003c/p\u003e\u003cp\u003eRAPN was associated with lower intraoperative complication rate compared to OPN (2% vs. 10%, p\u0026thinsp;=\u0026thinsp;0.003). RAPN resulted in lower EBL (200 mL vs. 300 mL, p\u0026thinsp;=\u0026thinsp;0.001), shorter operative time (147 vs. 170 min, p\u0026thinsp;=\u0026thinsp;0.001), and reduced LOS (median 6 days, p\u0026thinsp;=\u0026thinsp;0.001). Postoperative complications were less frequent with RAPN (14% vs. 25%, p\u0026thinsp;=\u0026thinsp;0.01), with no significant differences in severe complications or positive surgical margins. Five-year OS, CSS, and RFS were similar between groups.\u003c/p\u003e\u003cp\u003e\u003cb\u003eConclusions\u003c/b\u003e:\u003c/p\u003e\u003cp\u003eRAPN provides significant perioperative advantages over OPN without compromising oncologic safety at 5 years. These findings support broader adoption of RAPN in selected patients. Multicenter studies are warranted to assess cost-effectiveness, long-term functional outcomes, and generalizability.\u003c/p\u003e","manuscriptTitle":"Robot-Assisted versus Open Partial Nephrectomy: Propensity-Matched Perioperative Outcomes and Oncologic Safety up to 5 Years","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-09-23 15:48:33","doi":"10.21203/rs.3.rs-7474859/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"87707baa-af45-4043-a1fc-d19d59de2bbc","owner":[],"postedDate":"September 23rd, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-12-29T16:02:52+00:00","versionOfRecord":{"articleIdentity":"rs-7474859","link":"https://doi.org/10.1007/s11255-025-04977-2","journal":{"identity":"international-urology-and-nephrology","isVorOnly":false,"title":"International Urology and Nephrology"},"publishedOn":"2025-12-27 15:57:20","publishedOnDateReadable":"December 27th, 2025"},"versionCreatedAt":"2025-09-23 15:48:33","video":"","vorDoi":"10.1007/s11255-025-04977-2","vorDoiUrl":"https://doi.org/10.1007/s11255-025-04977-2","workflowStages":[]},"version":"v1","identity":"rs-7474859","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7474859","identity":"rs-7474859","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}