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Multicenter Study
. 2021 Aug;35(8):4295-4304.
doi: 10.1007/s00464-020-07919-4. Epub 2020 Aug 27.

Transperitoneal vs retroperitoneal minimally invasive partial nephrectomy: comparison of perioperative outcomes and functional follow-up in a large multi-institutional cohort (The RECORD 2 Project)

Francesco Porpiglia  1 , Andrea Mari  2 , Daniele Amparore  1 , Cristian Fiori  1 , Alessandro Antonelli  3 , Walter Artibani  4 , Pierluigi Bove  5 , Eugenio Brunocilla  6   7 , Umberto Capitanio  8 , Luigi Da Pozzo  9 , Fabrizio Di Maida  1 , Paolo Gontero  10 , Nicola Longo  11 , Giancarlo Marra  10 , Bernardo Rocco  12   13 , Riccardo Schiavina  6 , Claudio Simeone  3 , Salvatore Siracusano  4 , Riccardo Tellini  1 , Carlo Terrone  14 , Donata Villari  15 , Vincenzo Ficarra  16 , Marco Carini  1 , Andrea Minervini  17   18 ; RECORD 2 Project
Collaborators, Affiliations
Multicenter Study

Transperitoneal vs retroperitoneal minimally invasive partial nephrectomy: comparison of perioperative outcomes and functional follow-up in a large multi-institutional cohort (The RECORD 2 Project)

Francesco Porpiglia et al. Surg Endosc. 2021 Aug.

Abstract

Background: Aim of this study was to evaluate and compare perioperative outcomes of transperitoneal (TP) and retroperitoneal (TR) approaches in a multi-institutional cohort of minimally invasive partial nephrectomy (MI-PN).

Material and methods: All consecutive patients undergone MI-PN for clinical T1 renal tumors at 26 Italian centers (RECORd2 project) between 01/2013 and 12/2016 were evaluated, collecting the pre-, intra-, and postoperative data. The patients were then stratified according to the surgical approach, TP or RP. A 1:1 propensity score (PS) matching was performed to obtain homogeneous cohorts, considering the age, gender, baseline eGFR, surgical indication, clinical diameter, and PADUA score.

Results: 1669 patients treated with MI-PN were included in the study, 1256 and 413 undergoing TP and RP, respectively. After 1:1 PS matching according to the surgical access, 413 patients were selected from TP group to be compared with the 413 RP patients. Concerning intraoperative variables, no differences were found between the two groups in terms of surgical approach (lap/robot), extirpative technique (enucleation vs standard PN), hilar clamping, and ischemia time. Conversely, the TP group recorded a shorter median operative time in comparison with the RP group (115 vs 150 min), with a higher occurrence of intraoperative overall, 21 (5.0%) vs 9 (2.1%); p = 0.03, and surgical complications, 18 (4.3%) vs 7 (1.7%); p = 0.04. Concerning postoperative variables, the two groups resulted comparable in terms of complications, positive surgical margins and renal function, even if the RP group recorded a shorter median drainage duration and hospital length of stay (3 vs 2 for both variables), p < 0.0001.

Conclusions: The results of this study suggest that both TP and RP are feasible approaches when performing MI-PN, irrespectively from tumor location or surgical complexity. Notwithstanding longer operative times, RP seems to have a slighter intraoperative complication rate with earlier postoperative recovery when compared with TP.

Keywords: Minimally invasive partial nephrectomy; Renal cell carcinoma; Retroperitoneal; Surgical approach; Transperitoneal.

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Figures

Fig. 1
Fig. 1
Distribution of transperitoneal and retroperitoneal surgical procedures according to each single centre after propensity score matching analysis
See this image and copyright information in PMC

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