Comparison of Posterior and Antero-Lateral Renal Tumors in Retroperitoneal Laparoscopic Partial Nephrectomy: A Propensity Score Matching Analysis

Main Article Content

Hakan Anıl
Ali Yıldız
Ahmet Güzel
Serkan Akdemir
Kaan Karamık
Murat Arslan

Keywords

anterior, laparoscopy, partial nephrectomy, posterior, renal masses

Abstract

This study aimed to compare the antero-lateral and posterior localized renal masses in laparoscopic partial nephrectomy with the retroperitoneal approach in terms of operative, functional, and oncological outcomes. Patients who underwent retroperitoneal laparoscopic partial nephrectomy by a single surgeon between January 2013 and January 2021 were included in the study. A one-to-one propensity score matching (PSM) analysis was conducted to obtain two balanced groups. The patients were divided into two groups as posterior and antero-lateral according to the localization of the mass. A total of 239 patients were included in the PSM analysis, with 65 patients allocated to each group. The mean operative time was 79.2 ± 11.2 min in the posterior group, while it was 90.0 ± 11.6 min in the antero-lateral group (P < 0.001). Warm ischemia time was 15.9 ± 2.4 min in the posterior group and 18.6 ± 2.7 min in the antero-lateral group (P < 0.001). The median decrease in eGFR at 1 year was 4.8 (IQR, 2.9–6.9) mL/min in the posterior group and 5.0 (IQR, 2.8–11) mL/min in the antero-lateral group (P = 0.219). The warm ischemia time and clamping technique were found to be significant factors for predicting eGFR change after surgery (β:0.693, 95% CI: 0.39–0.99, P < 0.001; β:6.43, 95% CI: 1.1–11.7, P = 0.017, respectively). We report that retroperitoneal laparoscopic partial nephrectomy provided longer warm -ischemia and operative time for antero-lateral renal masses than posterior masses. However, long-term oncological and functional results were similar for both localizations.

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References

1. Ljungberg B, Albiges L, Abu-Ghanem Y, Bensalah K, Dabestani S, Fernández-Pello S, et al. European Association of Urology Guidelines on renal cell carcinoma: The 2019 Update. Eur Urol. 2019;75:799–810. 10.1016/j.eururo.2019.02.011

2. de Castro Abreu AL, Cacciamani G, Gill IS. Partial pephrectomy. In: Sotelo R, Arriaga J, Aron M, editors. Complications in robotic urologic surgery. Springer; Gewerbestrasse, Switzerland, 2018. p. 163–73.

3. Ren T, Liu Y, Zhao X, Ni S, Zhang C, Guo C, et al. Transperitoneal approach versus retroperitoneal approach: A meta-analysis of laparoscopic partial nephrectomy for renal cell carcinoma. PLoS One. 2014; 9:e91978. 10.1371/journal.pone.0091978

4. Fu J, Ye S, Ye HJ. Retroperitoneal versus transperitoneal laparoscopic partial nephrectomy: A systematic review and meta-analysis. Chin Med Sci J. 2015;30:239–44. 10.1016/s1001-9294(16)30007-4

5. Wright JL, Porter JR. Laparoscopic partial nephrectomy: Comparison of transperitoneal and retroperitoneal approaches. J Urol. 2005;174: 841–5. 10.1097/01.ju.0000169423.94253.46

6. Sciorio C, Prontera PP, Scuzzarella S, Verze P, Spirito L, Romano L, et al. Predictors of surgical outcomes of retroperitoneal laparoscopic partial nephrectomy. Arch Ital Urol Androl. 2020;92(3): 165–8. 10.4081/aiua.2020.3.165

7. Kim HY, Choe HS, Lee DS, Yoo JM, Lee SJ. Extending the indication for robot-assisted retroperitoneal partial nephrectomy to antero-lateral renal tumors. Int J Med Robot. 2017;13(2). 10.1002/rcs.1755

8. Kutikov A, Uzzo RG. The R.E.N.A.L. nephrometry score: A comprehensive standardized system for quantitating renal tumor size, location and depth. J Urol. 2009;182:844–53. 10.1016/j.juro.2009.05.035

9. Rassweiler JJ, Klein J, Tschada A, Gözen AS. Laparoscopic retroperitoneal partial nephrectomy using an ergonomic chair: Demonstration of technique and matched-pair analysis. BJU Int. 2017;119:349–57. 10.1111/bju.13627

10. Dindo D, Demartines N, Clavien PA. Classification of surgical complications: A new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 2004;240:205–13. 10.1097/01.sla.0000133083.54934.ae

11. Thoemmes F. Propensity score matching in SPSS. University of Tübingen, Cham; 2012.

12. Marconi L, Challacombe B. Robotic partial nephrectomy for posterior renal tumours: Retro or transperitoneal approach? Eur Urol Focus. 2018;4(5):632–5. 10.1016/j.euf.2018.08.003

13. Paulucci DJ, Beksac AT, Porter J, Abaza R, Eun DD, Bhandari A, et al. A Multi-institutional propensity score matched comparison of transperitoneal and retroperitoneal partial nephrectomy for cT1 posterior tumors. J Laparoendosc Adv Surg Tech A. 2019;29(1):29–34. 10.1089/lap.2018.0313

14. Laviana AA, Tan HJ, Hu JC, Weizer AZ, Chang SS, Barocas D. Retroperitoneal versus transperitoneal robotic-assisted laparoscopic partial nephrectomy: A matched-pair, bicenter analysis with cost comparison using time-driven activity-based costing. Curr Opin Urol. 2018;28(2):108–14. 10.1097/MOU.0000000000000483

15. Ferakis N, Katsimantas A, Charalampogiannis N, Paparidis S, Rassweiler JJ, Gozen AS. Transperitoneal and retroperitoneal approach in laparoscopic partial nephrectomy for posterior cT1 renal tumors: A retrospective, two-centers, comparative study. Arch Ital Urol Androl. 2020;92(3). 10.4081/aiua.2020.3.230

16. Harris KT, Ball MW, Gorin MA, Curtiss KM, Pierorazio PM, Allaf ME. Transperitoneal robot-assisted partial nephrectomy: A comparison of posterior and anterior renal masses. J Endourol. 2014;28(6):655–9. 10.1089/end.2013.0608

17. Tanaka K, Shigemura K, Furukawa J, Ishimura T, Muramaki M, Miyake H, et al. Comparison of the transperitoneal and retroperitoneal approach in robotassisted partial nephrectomy in an initial case series in Japan. J Endourol 2013;27:1384–8. 10.1089/end.2012.0641

18. Stroup SP, Hamilton ZA, Marshall MT, Lee HJ, Berquist SW, Hassan AS, et al. Comparison of retroperitoneal and transperitoneal robotic partial nephrectomy for Pentafecta perioperative and renal functional outcomes. World J Urol. 2017;35(11):1721–8. 10.1007/s00345-017-2062-0

19. Harke NN, Darr C, Radtke JP, von Ostau N, Schiefelbein F, Eraky A, et al. Retroperitoneal versus transperitoneal robotic partial nephrectomy: A multicenter matched-pair analysis. Eur Urol Focus. 2021;7(6):1363–70. 10.1016/j.euf.2020.08.012

20. Hung AJ, Cai J, Simmons MN, Gill IS. “Trifecta” in partial nephrectomy. J Urol. 2013;189(1):36–42. 10.1016/j.juro.2012.09.042

21. Zargar H, Allaf ME, Bhayani S, Stifelman M, Rogers C, Ball MW, et al. Trifecta and optimal perioperative outcomes of robotic and laparoscopic partial nephrectomy in surgical treatment of small renal masses: A multi-institutional study. BJU Int. 2015;116:407–14. 10.1111/bju.12933