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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 AutorinoEmail author
Original Article

Abstract

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.

Keywords

Radical nephrectomy Robotic Laparoscopic Comparative outcomes Complications 

Notes

Authors’ contribution

Protocol/project development: RA, UAA, ID, FP. Data collection or management: UAA, MCM, NL, AM, KC, CF, JS, WW, GQ, AB, AA, FB, CZ, AL, PK, ML. Data analysis: UAA, MM. Manuscript writing: RA, UAA, ID. Manuscript editing: BY, GS, RGU, CL, MCM, UC, JP, AM, WW, SP, LS, MG, MR-B, CPS, AM, AK, KHR, PD, BC, LJH, FP, MA.

Compliance with ethical standards

Conflict of interest

The author(s) declare that they have no competing interests.

Research involving human participants and/or animals

The ROSULA database is an IRB-approved study at the participating centers.

Informed consent

Patients included in this retrospective analysis had signed an informed consent at the time of surgery.

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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  • Uzoma A. Anele
    • 1
  • Michele Marchioni
    • 2
  • Bo Yang
    • 3
  • Giuseppe Simone
    • 4
  • Robert G. Uzzo
    • 5
  • Clayton Lau
    • 6
  • Maria C. Mir
    • 7
  • Umberto Capitanio
    • 8
  • James Porter
    • 9
  • Ken Jacobsohn
    • 10
  • Nicolo de Luyk
    • 11
  • Andrea Mari
    • 12
  • Kidon Chang
    • 13
  • Cristian Fiori
    • 14
  • Jay Sulek
    • 15
  • Alexandre Mottrie
    • 16
    • 17
  • Wesley White
    • 18
  • Sisto Perdona
    • 19
  • Giuseppe Quarto
    • 19
  • Ahmet Bindayi
    • 20
  • Akbar Ashrafi
    • 21
  • Luigi Schips
    • 2
  • Francesco Berardinelli
    • 2
  • Chao Zhang
    • 3
  • Michele Gallucci
    • 4
  • Miguel Ramirez-Backhaus
    • 7
  • Alessandro Larcher
    • 8
    • 16
  • Patrick Kilday
    • 6
  • Michael Liao
    • 9
  • Peter Langenstroer
    • 10
  • Prokar Dasgupta
    • 11
    • 22
  • Ben Challacombe
    • 11
  • Alexander Kutikov
    • 5
  • Andrea Minervini
    • 12
  • Koon Ho Rha
    • 13
  • Chandru P. Sundaram
    • 15
  • Lance J. Hampton
    • 1
  • Francesco Porpiglia
    • 14
  • Monish Aron
    • 21
  • Ithaar Derweesh
    • 20
  • Riccardo Autorino
    • 1
    Email author
  1. 1.Division of UrologyVirginia Commonwealth University School of MedicineRichmondUSA
  2. 2.Department of UrologySS Annunziata Hospital, “G.D’Annunzio” University of ChietiChietiItaly
  3. 3.Department of UrologyChanghai HospitalShanghaiChina
  4. 4.Department of UrologyIRCCS - “Regina Elena” National Cancer InstituteRomeItaly
  5. 5.Division of UrologyFox Chase Cancer CenterPhiladelphiaUSA
  6. 6.Division of UrologyCity of Hope Medical CenterDuarteUSA
  7. 7.Department of UrologyFundacion Instituto Valenciano OncologiaValenciaSpain
  8. 8.Unit of Urology, Division of OncologyUrological Research Institute, IRCCS Ospedale San RaffaeleMilanItaly
  9. 9.Swedish Urology GroupSeattleUSA
  10. 10.Department of UrologyMedical College WisconsinMilwaukeeUSA
  11. 11.Urology Centre, Guy’s and St Thomas’s NHS Foundation TrustLondonUK
  12. 12.Department of UrologyUniversity of Florence, Careggi HospitalFlorenceItaly
  13. 13.Department of Urology, Yonsei WonjuUniversity College of MedicineWonjuKorea
  14. 14.Department of UrologyUniversity of Turin-San Luigi Gonzaga HospitalTurinItaly
  15. 15.Department of UrologyIndiana University School of MedicineIndianapolisUSA
  16. 16.ORSI AcademyMelleBelgium
  17. 17.Department of UrologyOLV HospitalAalstBelgium
  18. 18.Department of UrologyUniversity of Tennessee Medical CenterKnoxvilleUSA
  19. 19.SC Urologia, Istituto Nazionale Tumori IRCCSFondazione PascaleNapoliItaly
  20. 20.Department of UrologyUC San Diego Health SystemLa JollaUSA
  21. 21.Institute of Urology, University of Southern CaliforniaLos AngelesUSA
  22. 22.MRC Centre for Transplantation, NIHR Biomedical Research CentreKing’s CollegeLondonUK

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