Perioperative Outcomes of Open, Laparoscopic, and Robotic Partial Nephrectomy: A Prospective Multicenter Observational Study (The RECORd 2 Project)

Background: Partial nephrectomy (PN) has a non-negligible perioperative morbidity. Comparative evidence of the available surgical techniques is limited. Objective: To compare the perioperative outcomes of open, laparoscopic, and robotic PN. Methods: Data of 2331 patients treated with PN for cT1 renal tumors were extracted from the RECORd2 database, a prospective multicenter project. Multivariable regression models assessed the relationship between surgical technique and surgical margins, warm ischemia time, postoperative complications, and acute kidney injury (AKI). The probability of achieving a modified trifecta (negative margins, warm ischemia time <25 min, and no Clavien–Dindo ≥2 complications) was examined for each surgical approach. Results: Minimally invasive techniques had lower rate of Clavien–Dindo ≥2 complications than that of open surgery (odds ratio [OR] for robotic surgery: 0.27; 95% confidence interval [95% CI]: 0.15–0.47, p < 0.0001; OR for laparoscopy: 0.52; 95% CI: 0.34–0.78; p = 0.002). The probability of receiving ischemia was highest for robotic PN (p < 0.001). Among on-clamp PN, laparoscopy had longer ischemia than open (estimate: 1.09; 95% CI: –0.00 to 2.18; p = 0.050) and robotic (estimate: 1.36; 95% CI: 0.31–2.40; p = 0.011) surgery. When compared with open PN, the risk of AKI was roughly halved for patients treated by robotic and laparoscopic surgery (both p < 0.0001). Positive margins rate did not differ between the groups (all p ≥ 0.1). The likelihood to achieve a modified trifecta was not affected by surgical technique in the overall population (all p ≥ 0.075). In Preoperative Aspects and Dimensions Used for an Anatomical (PADUA) score < 10 lesions, robotic surgery had higher probability of achieving a modified trifecta than open PN (OR: 1.66; 95% CI: 1.09–2.53; p = 0.018) and laparoscopy (OR: 1.34; 95% CI: 0.94–1.90; p = 0.11). Conclusions: In PADUA < 10 renal tumors, robotic PN allows for higher rates of trifecta than