Transperitoneal vs retroperitoneal minimally invasive partial nephrectomy: comparison of perioperative outcomes and functional follow-up in a large multi-institutional cohort (The RECORD 2 Project)

Alchiede Simonato, Andrea Polara, Gaetano Grosso, Matteo Ferro, Riccardo Schiavina, Umberto Capitanio, Francesco Berardinelli, Alessandro Larcher, Claudio Simeone, Alessandro Volpe, Alessandro Antonelli, Daniele Amparore, Mario Falsaperla, Maria Furlan, Nicola Longo, Carlo Terrone, Giancarlo Marra, Alberto Diminutto, Angelo Porreca, Riccardo RizzettoFabrizio Di Maida, Elisabetta Costantini, Riccardo Tellini, Bernardo Rocco, Andrea Mari, Antonio Celia, Eugenio Brunocilla, Andrea Minervini, Luigi Schips, Marco Roscigno, Vincenzo Li Marzi, Vincenzo Altieri, Paolo Gontero, Pierluigi Bove, Luigi Da Pozzo, Alchiede Simonato, Donata Villari, Sergio Serni, Francesco Porpiglia, Giuseppe Vespasiani, Carlo Trombetta, Salvatore Siracusano, Vincenzo Ficarra, Cristian Fiori, Walter Artibani, Cesare Selli, Francesco Montorsi, Marco Carini

Risultato della ricerca: Articlepeer review

Abstract

Background: Aim of this study was to evaluate and compare perioperative outcomes of transperitoneal (TP) and retroperitoneal (TR) approaches in a multi-institutional cohort of minimally invasive partial nephrectomy (MI-PN). Material and methods: All consecutive patients undergone MI-PN for clinical T1 renal tumors at 26 Italian centers (RECORd2 project) between 01/2013 and 12/2016 were evaluated, collecting the pre-, intra-, and postoperative data. The patients were then stratified according to the surgical approach, TP or RP. A 1:1 propensity score (PS) matching was performed to obtain homogeneous cohorts, considering the age, gender, baseline eGFR, surgical indication, clinical diameter, and PADUA score. Results: 1669 patients treated with MI-PN were included in the study, 1256 and 413 undergoing TP and RP, respectively. After 1:1 PS matching according to the surgical access, 413 patients were selected from TP group to be compared with the 413 RP patients. Concerning intraoperative variables, no differences were found between the two groups in terms of surgical approach (lap/robot), extirpative technique (enucleation vs standard PN), hilar clamping, and ischemia time. Conversely, the TP group recorded a shorter median operative time in comparison with the RP group (115 vs 150 min), with a higher occurrence of intraoperative overall, 21 (5.0%) vs 9 (2.1%); p = 0.03, and surgical complications, 18 (4.3%) vs 7 (1.7%); p = 0.04. Concerning postoperative variables, the two groups resulted comparable in terms of complications, positive surgical margins and renal function, even if the RP group recorded a shorter median drainage duration and hospital length of stay (3 vs 2 for both variables), p < 0.0001. Conclusions: The results of this study suggest that both TP and RP are feasible approaches when performing MI-PN, irrespectively from tumor location or surgical complexity. Notwithstanding longer operative times, RP seems to have a slighter intraoperative complication rate with earlier postoperative recovery when compared with TP.
Lingua originaleEnglish
Numero di pagine10
RivistaSurgical Endoscopy
Stato di pubblicazionePublished - 2020

All Science Journal Classification (ASJC) codes

  • Surgery

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