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Robotic versus laparoscopic radical nephrectomy: a large multi-institutional analysis (ROSULA Collaborative Group)

 Uzoma A. Anele  ;  Michele Marchioni  ;  Bo Yang  ;  Giuseppe Simone  ;  Robert G. Uzzo  ;  Clayton Lau  ;  Maria C. Mir  ;  Umberto Capitanio  ;  James Porter  ;  Ken Jacobsohn  ;  Nicolo de Luyk  ;  Andrea Mari  ;  Kidon Chang  ;  Cristian Fiori  ;  Jay Sulek  ;  Alexandre Mottrie  ;  Wesley White  ;  Sisto Perdona  ;  Giuseppe Quarto  ;  Ahmet Bindayi  ;  Akbar Ashrafi  ;  Luigi Schips  ;  Francesco Berardinelli  ;  Chao Zhang  ;  Michele Gallucci  ;  Miguel Ramirez-Backhaus  ;  Alessandro Larcher  ;  Patrick Kilday  ;  Michael Liao  ;  Peter Langenstroer  ;  Prokar Dasgupta  ;  Ben Challacombe  ;  Alexander Kutikov  ;  Andrea Minervini  ;  Koon Ho Rha  ;  Chandru P. Sundaram  ;  Lance J. Hampton  ;  Francesco Porpiglia  ;  Monish Aron  ;  Ithaar Derweesh  ;  Riccardo Autorino 
 WORLD JOURNAL OF UROLOGY, Vol.37(11) : 2439-2450, 2019 
Journal Title
Issue Date
Comparative outcomes ; Complications ; Laparoscopic ; Radical nephrectomy ; Robotic
OBJECTIVE: To compare the outcomes of robotic radical nephrectomy (RRN) to those of laparoscopic radical nephrectomy (LRN) for large renal masses. METHODS: This was a retrospective analysis of RRN and LRN cases performed for large (≥ cT2) renal masses from 2004 to 2017 and collected in the multi-institutional international database (ROSULA: RObotic SUrgery for LArge renal masses). Peri-operative, functional, and oncologic outcomes were compared between each approach. Descriptive analyses were performed and presented as medians with interquartile ranges. Inverse probability of treatment weighting-adjusted multivariable analyses were used to identify predictors of peri-operative complications. Kaplan-Meier analysis and Cox regression models were used to assess survival outcomes. RESULTS: A total of 941 patients (RRN = 404, LRN = 537) were identified. There was no difference in terms of gender, age, and clinical tumor size. Over the study period, RRN had an annual increase of 11.75% (95% CI [7.34, 17.01] p < 0.001) and LRN had an annual decline of 5.39% (95% CI [-6.94, -3.86] p < 0.001). Patients undergoing RRN had higher BMI (27.6 [IQR 24.8-31.1] vs. 26.5 [24.1-30.0] kg/m2, p < 0.01). Operative duration was longer for RRN (185.0 [150.0-237.2] vs. 126 [90.8-180.0] min, p < 0.001). Length of stay was shorter for RRN (3.0 [2.0-4.0] vs. 5.0 [4.0-7.0] days, p < 0.001). RRN cases presented more advanced disease (higher pathologic staging [pT3-4 52.5 vs. 24.2%, p < 0.001], histologic grade [high grade 49.3 vs. 30.4%, p < 0.001], and rate of nodal disease [pN1 5.4 vs. 1.9%, p < 0.01]). Surgical approach did not represent an independent risk factor for peri-operative complications (OR 1.81 95% CI [0.97-3.39], adjusted p = 0.2). The main study limitation is the retrospective design. CONCLUSIONS: This study represents the largest known multi-center comparison between RRN and LRN. The two procedures seem to offer similar peri-operative outcomes. Notably, RRN has been increasingly utilized, especially in the setting of more advanced and surgically challenging disease without increasing the risk of peri-operative complications.
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1. College of Medicine (의과대학) > Dept. of Urology (비뇨의학교실) > 1. Journal Papers
Yonsei Authors
Rha, Koon Ho(나군호) ORCID logo https://orcid.org/0000-0001-8588-7584
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