Surgical Outcomes of the Non-renorrhaphy Technique During Robot-Assisted Partial Nephrectomy for Highly Complex Renal Tumors (RENAL Score ≥ 10).

Abstract

Objectives: Non-renorrhaphy technique during partial nephrectomy has not been sufficiently studied. This study aimed to evaluate the surgical outcomes of the non-renorrhaphy technique in robot-assisted partial nephrectomy (RAPN) for tumors with RENAL scores of 10-12.

Methods: We retrospectively analyzed 51 consecutive patients who underwent RAPN with or without renorrhaphy for RENAL score 10-12 tumors at Osaka Metropolitan University Hospital between March 2015 and December 2023. Perioperative outcomes were compared between 16 patients in the nonrenorrhaphy group and 35 patients in the renorrhaphy group. Univariate and multivariate linear regression analyses were conducted to identify predictors of renal function and renal parenchymal volume preservation.

Results: Patient demographics and preoperative tumor characteristics exhibited no significant differences between the two groups. Operative time was significantly shorter in the nonrenorrhaphy group (185 vs. 217 min, p = 0.0016). The preservation rate of renal parenchymal volume was significantly higher in the nonrenorrhaphy group (86.7 vs. 74.2%, p = 0.0016), but there was no significant difference in the preservation rate of estimated glomerular filtration rate (p = 0.6380). No significant difference was observed in the incidence of major complications (Clavien-Dindo grade ≥ 3) between the two groups. Urinary leakage occurred in both groups (p = 0.9399). In univariate and multivariate analyses, renorrhaphy and clinical tumor size were identified as significant predictors of renal parenchymal volume preservation.

Conclusions: Even in cases with RENAL scores of 10-12, the non-renorrhaphy technique appears to be a feasible and safe approach, and may be associated with better preservation of renal parenchymal volume.