Transperitoneal robot-assisted partial nephrectomy: a comparison of operative and oncological outcomes between posterior and anterolateral tumours.

Objective: To compare operative and oncological outcomes, as well as the risk of postoperative complications in patients who underwent transperitoneal robot-assisted partial nephrectomy (RAPN) for renal tumours located either posteriorly or anterolaterally.

Methods: Retrospective, consecutive study including 451 patients who underwent transperitoneal RAPN for non-metastatic, localised renal tumours from May 2016 to April 2023. Operative data included duration of the procedure, warm ischaemia time, and blood loss; oncological data included surgical margins and recurrence; and 90-day postoperative complications were classified according to the Clavien-Dindo classification.

Results: In total, 140 (31%) patients had tumours with a posterior location. The median follow-up was 3.3 (IQR 1.8-5.0) years. There were no differences in operative outcomes or length of hospital stay between the two groups. Positive surgical margins were recorded in 9% of the patients with posterior tumours compared to 7% of patients with anterolateral tumours, p = 0.60. The estimated probability of recurrence-free survival at 5 years was 95.2% (95% CI 87.4-98.2) for patients with posterior tumours and 96.7% (95% CI 92.3-98.6) for patients with anterolateral tumours, p = 0.4. Patients with posterior tumours had a similar risk of any complication (OR 1.24 [95% CI 0.80-1.91]) and CD ≥ III (OR 0.73 [95% CI 0.28-1.67]) compared to patients with anterolateral tumours.

Conclusion: This study found that patients with posterior tumours had longer operating times and hospital stays following transperitoneal RAPN compared to those with anterolateral tumours but without increased complications or poorer oncological outcomes.