Evaluation of Complication, Renal Function, and Recurrence-Free Survival in Hilar and Non-Hilar Tumors During Robot-Assisted Partial Nephrectomy: A Propensity Score-Matched Analysis.

Abstract

Objective: To compare complications, perioperative outcomes, postoperative renal function, and recurrence-free survival (RFS) between robot-assisted partial nephrectomy (RAPN) for hilar and non-hilar tumors.

Methods: We retrospectively analyzed the medical records of patients who underwent RAPN between March 2016 and August 2023. Patient demographic characteristics were adjusted using 1:1 propensity score matching.

Results: A total of 618 patients (524 with non-hilar tumors and 94 with hilar tumors) were analyzed. Hilar tumors exhibited a larger tumor size, higher RENAL nephrometry score (RNS), and greater complexity than non-hilar tumors pre-matching (all p < 0.05). Propensity score matching resulted in 77 patients per group, with no significant baseline differences except for the L factor of the RNS. Before propensity score matching, hilar tumors were associated with a higher frequency of renal artery/vein clamping and intraperitoneal approaches, as well as significantly longer operative and warm ischemia times than non-hilar tumors. However, after matching, these differences were no longer significant. The adverse event rate was not significantly different between the hilar and non-hilar tumor groups. Trifecta achievement rates were significantly lower in hilar tumors before matching (p < 0.001) but were comparable after matching (p = 0.325). No significant differences were observed in the postoperative eGFR, preservation at 1, 3, and 12 months, or pentafecta rates. Before matching, RFS was significantly lower in hilar tumors (p = 0.015); however, this difference was not significant after matching (p = 0.186).

Conclusion: Hilar tumors showed similar complications, renal function, and recurrence-free survival rates as non-hilar tumors, indicating that RAPN is safe and feasible for hilar tumors.