A Multi-Institutional Propensity Score Matched Comparison of Transperitoneal and Retroperitoneal Partial Nephrectomy for cT1 Posterior Tumors.

Objective: To compare the perioperative and renal functional outcome between transperitoneal and retroperitoneal robotic partial nephrectomy (TP-RPN and RP-RPN) in the largest cohort to date of RP-RPN for posterior tumors.
Methods: We identified 519 patients who met eligibility criteria and underwent TP-RPN (n = 357, 68.8%) or RP-RPN (n = 162, 31.2%) for a posteriorly located cT1 tumor. Patients were propensity score (PS) matched on preoperative and tumor-specific characteristics. Perioperative outcome and renal function outcome at median follow-up 22 months were compared.
Results: Between the PS matched TP-RPN (n = 157, 50%) and RP-RPN (n = 157, 50%) patients, operative time (OT) (185.0 versus 157.0, P < .001) was longer in TP-RPN versus RP-RPN patients. No significant differences in ischemia time (P = .618), blood loss (P = .178), positive surgical margins (P = .501), overall postoperative complications (P = .861), or progression of chronic kidney disease stage at median 22 months (P = .599) were identified. Length of stay (LOS) was reduced in RP-RPN patients (P = .017), but was not different once an institution used a postoperative day (POD)-1 discharge protocol (P = .579). Operative times were similar between groups in patients with obesity (P = .293) or a cT1b renal mass (P = 908).
Conclusion: RP-RPN for posterior tumors resulted in reduced OT and a shorter LOS compared to TP-RPN. When surgeons aimed to routinely discharge patients on POD-1, the surgical approach did not influence LOS. Operative time was similar between RP and TP-RPN among patients with obesity or a cT1b renal mass. All other measures, including ischemia time, blood loss, margin rates, complications, and renal function, did not differ between the two approaches.