Giovanni E. Cacciamani, MD
For patients with early kidney cancer, surgically removing a portion of the kidney instead of the whole organ is often a preferred treatment, because the procedure can effectively remove tumors while preserving kidney function. But when it comes to the best surgical approach—robotic, laparoscopic, or open—for this procedure, known as partial nephrectomy, the choice has been less clear. A comprehensive study by the Keck School of Medicine at the University of Southern California (USC) has found that robotic partial nephrectomy offers significantly better patient outcomes compared with other surgical methods. Findings were published by Giovanni E. Cacciamani, MD, and colleagues in The Journal of Urology.
“Robotic partial nephrectomy has become increasingly more common, yet there’s a lack of consensus among urologists about its performance vis-à-vis open or laparoscopic techniques,” said the study’s corresponding author Inderbir Gill, MD, Chair and Distinguished Professor of Urology at Keck. “Our goal with this study was to critically evaluate the impact of these three techniques on patient outcomes such as complications, cancer recurrence, and mortality.”
The systematic review and meta-analysis combined data from 98 studies on robotic, open, and laparoscopic partial nephrectomy. More than 20,000 patients were included in the analysis.
When comparing robotic to open partial nephrectomy, the study found that robotic partial nephrectomy offered several superior patient outcomes, including decreased complications during and after surgery, cancer recurrence, overall mortality, hospital length of stay, and hospital readmission. There was no difference in cancer-specific mortality between the two techniques.
Results also showed that robotic partial nephrectomy was equivalent to, and sometimes better than, laparoscopic partial nephrectomy. While there was no difference in cancer recurrence, cancer-specific mortality, length of hospital stay, or readmission, a robotic technique was associated with lower overall mortality and fewer complications during and after surgery.
Dr. Gill, who is also the Executive Director of the USC Institute of Urology at Keck Medicine of USC, believes the data suggest that the technique of robotic partial nephrectomy has now become established in the field.
“Our study shows that robotic partial nephrectomy is not only safe and effective but also a preferred approach for treating small kidney tumors,” he concluded.
Cacciamani GE, et al: J Urol 200:258-274, 2018.