Robot-assisted laparoscopic partial nephrectomy is a safe and effective option for clinical T2 renal cell carcinoma: a case-series from single-institution

BACKGROUND: Robot-assisted laparoscopic partial nephrectomy (RAPN) is increasingly used in the treatment of complex renal tumors, but it is still not commonly performed for T2 renal tumors and the reports of RAPN for renal tumors ≥7 cm were limited. Here we report our single-institution outcomes to evaluate the safety and efficacy of RAPN in treating T2 renal tumors. METHODS: This study was designed as a case-series study. We retrospectively reviewed our database and finally identified 16 patients undergoing RAPN for clinical T2 tumors. Seven patients who underwent standard laparoscopic partial nephrectomy (LPN) and 30 patients who were treated by radical nephrectomy(RN) were included as controls. The baseline characteristics, perioperative outcomes, change of renal function, and oncological outcomes were analyzed. RESULTS: There was no significant difference between groups in baseline characteristics, intraoperative complications, and long-term oncological outcomes. Both RAPN and LPN had a longer operative time and higher blood loss compared with RN, but they could offer better renal function reservation. Two patients who underwent LPN converted to radical nephrectomy or open partial nephrectomy and no conversions happened in the RAPN group. The ischemia time seemed shorter in RAPN group but did not reach statistical significance (median 20.0 vs. 25.5 min, P=0.118). Except for blood transfusions, no other major complication was detected. CONCLUSIONS: RAPN can provide fair preservation of renal function with acceptable major complications and oncological outcomes, therefore it is a safe and effective procedure for renal tumors ≥7 cm. Its advantages over LPN still need to be ascertained by further studies with better design and larger sample sizes.