Open versus robotic partial nephrectomy in obese patients: a multi-institutional propensity score-matched analysis (UroCCR 43—Robese study)

期刊论文
发表日期：

2024年4月6日

查看全文

Jean Baptiste Beauval,
Zine-Eddine Khene,
Mathieu Roumiguié,
Razvan Rahota,
Arnaud Mejean,
Nicolas Doumerc,
Morgan Roupret,
Philippe Paparel,
Arnauld Villers,
Franck Bruyere,
Cédric Lebacle,
François Xavier Nouhaud,
Cécile Champy,
Alexandre de la Taille,
Hervé Lang,
Jérome Rizk,
Mathieu Durand,
Charles Dariane,
Thomas Charles,
Romain Boissier,
Jean Alexandre Long,
Pierre Bigot,
Karim Bensalah,
Jean Christophe Bernhard

摘要

Introduction

There is limited evidence on the outcomes of robotic partial nephrectomy (RPN) and open partial nephrectomy (OPN) in obese patients (BMI ≥ 30 kg/m²). In this study, we aimed to compare perioperative and oncological outcomes of RPN and OPN.

Methods

We relied on data from patients who underwent PN from 2009 to 2017 at 16 departments of urology participating in the UroCCR network, which were collected prospectively. In an effort to adjust for potential confounders, a propensity-score matching was performed. Perioperative outcomes were compared between OPN and RPN patients. Disease-free survival (DFS) and overall survival (OS) were estimated using the Kaplan–Meier method and compared using the log-rank test.

Results

Overall, 1277 obese patients (932 robotic and 345 open were included. After propensity score matching, 166 OPN and 166 RPN individuals were considered for the study purposes; no statistically significant difference among baseline demographic or tumor‐specific characteristics was present. A higher overall complication rate and major complications rate were recorded in the OPN group (37 vs. 25%, p = 0.01 and 21 vs. 10%, p = 0.007; respectively). The length of stay was also significantly longer in the OPN group, before and after propensity-score matching (p < 0.001). There were no significant differences in Warm ischemia time (p = 0.66), absolute change in eGFR (p = 0.45) and positive surgical margins (p = 0.12). At a median postoperative follow-up period of 24 (8–40) months, DFS and OS were similar in the two groups (all p > 0.05).

Conclusions

In this study, RPN was associated with better perioperative outcomes (improvement of major complications rate and LOS) than OPN. The oncological outcomes were found to be similar between the two approaches.