Re: Robotic Partial Nephrectomy Vs Minimally Invasive Radical Nephrectomy For Clinical T2a Renal Mass: A Propensity Score-Matched Comparison From The Rosula (Robotic Surgery For Large Renal Mass) Collaborative Group

Objective To compare outcomes of minimally invasive radical nephrectomy (MIS-RN) and robot-assisted partial nephrectomy (RAPN) in clinical T2a renal mass (cT2aRM). Patients and Methods Retrospective, multicentre, propensity score-matched (PSM) comparison of RAPN and MIS-RN for cT2aRM (T2aN0M0). Cohorts were PSM for age, sex, body mass index, American Society of Anesthesiologists (ASA) class, clinical tumour size, and R.E.N.A.L. score using a 2:1 ratio for RN:PN. The primary outcome was disease-free survival (DFS). Secondary outcomes included overall survival (OS), complication rates, andde novoestimated glomerular filtration rate (eGFR) <45 mL/min/1.73 m(2). Multivariable (MVA) and Kaplan-Meier survival analyses (KMSA) were conducted. Results In all, 648 patients (216 RAPN/432 MIS-RN) were matched. There were no significant differences in intraoperative complications (P = 0.478), Clavien-Dindo Grade >= III complications (P = 0.063), and re-admissions (P = 0.238). The MVA revealed high ASA class (hazard ratio [HR] 2.7,P = 0.044) and sarcomatoid (HR 5.3,P = 0.001), but not surgery type (P = 0.601) to be associated with all-cause mortality. Increasing R.E.N.A.L. score (HR 1.31,P = 0.037), high tumour grade (HR 2.5,P = 0.043), and sarcomatoid (HR 2.8,P = 0.02) were associated with recurrence, but not surgery (P = 0.555). Increasing age (HR 1.1,P < 0.001) and RN (HR 3.9,P < 0.001) were predictors ofde novoeGFR of <45 mL/min/1.73 m(2). Comparing RAPN and MIS-RN, KMSA revealed no significant differences for 5-year OS (76.3% vs 88.0%,P = 0.221) and 5-year DFS (78.6% vs 85.3%,P = 0.630) for pT2 RCC, and no differences for 3-year OS (P = 0.351) and 3-year DFS (P = 0.117) for pT3a upstaged RCC. The 5-year freedom fromde novoeGFR of <45 mL/min/1.73 m(2)was 91.6% for RAPN vs 68.9% for MIS-RN (P < 0.001). Conclusions RAPN had similar oncological outcomes and morbidity profile as MIS-RN, while conferring functional benefit. RAPN may be considered as a first-line option for cT2aRM.