Transperitoneal vs retroperitoneal minimally invasive partial nephrectomy: comparison of perioperative outcomes and func
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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 Porpiglia1 · Andrea Mari2 · Daniele Amparore1 · Cristian Fiori1 · Alessandro Antonelli3 · Walter Artibani4 · Pierluigi Bove5 · Eugenio Brunocilla6,7 · Umberto Capitanio8 · Luigi Da Pozzo9 · Fabrizio Di Maida1 · Paolo Gontero10 · Nicola Longo11 · Giancarlo Marra10 · Bernardo Rocco12,13 · Riccardo Schiavina6 · Claudio Simeone3 · Salvatore Siracusano4 · Riccardo Tellini1 · Carlo Terrone14 · Donata Villari15 · Vincenzo Ficarra16 · Marco Carini1 · Andrea Minervini1,17 · The RECORD 2 Project Received: 6 March 2020 / Accepted: 17 August 2020 © The Author(s) 2020
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 50 mi-PNs per year, respectively. An overview of the distribution of surgical accesses for each center is shown in Fig. 1. Patients undergone RP were
treated in centers performing a median (IQR) of 71 (44–84) PNs/year, while the matched patients undergone TP underwent surgery in centers with a median of 56 (35–79) PN/year (p 30 and > 50 PNs/year, while of the TP cohort only 313 (75.8%) and 256 (62.0%) patients underwent surgery in centers performing > 30 and > 50 PNs/year (p
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