Purpose
Data regarding the long‐term oncologic and functional outcomes of robotic‐assisted, laparoscopic, and open partial nephrectomy (RPN, LPN and OPN) is lacking. Our aim was to compare outcomes among RPN, LPN and OPN with a 5‐year median follow‐up.
Patients and Methods
We retrospectively analyzed 1308 patients who underwent PN (RPN, n=380; LPN, n=206; OPN, n=722) between 2006 and 2012 at four academic centers. We performed 1:1:1 propensity score matching adjustment based on confounding variables among groups and 366 patients (122 in each group) were included in the final analysis. Survival rates were analyzed by Kaplan‐Meier method.
Results
The median follow‐up was 60, 59.8 and 64.1 months in RPN, LPN and OPN, respectively. In the matched groups, RPN showed significantly lower mean estimated blood loss compared to LPN (p=0.025) and OPN (p=0.040), while LPN had longer mean operative time compared to RPN (p=0.001) and OPN (p=0.001). The hospital stay was shorter in the RPN group (p=0.008). Regarding the oncological outcomes, there were no significant differences among the three groups in local recurrence rate (p=0.882), distant metastasis (p=0.816), and cancer death (p=0.779). At latest follow‐up, the incidence of chronic kidney disease (CKD) upstaging was significantly lower in RPN compared to LPN (20.55% vs 32%, p=0.035) and OPN (20.5% vs 33.6%, p=0.038). The 5‐year CKD free‐survival rate was significantly higher 78.4% in RPN compared to 58.8% and 65.8% in LPN and OPN, respectively (log‐rank, p=0.031).
Conclusions
Our study showed that RPN, LPN, and OPN have similar local recurrence, distant metastasis and cancer‐related death rates at a 5‐year median follow‐up. In terms of functional outcomes, RPN shows a lower incidence of CKD upstaging compared to OPN and LPN
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