Impact of RoSCo-based preoperative risk stratification on early mobilization and short-term outcomes following robot-assisted laparoscopic partial nephrectomy for renal cell carcinoma: a single-center prospective study.

Abstract

This study aimed to evaluate the effectiveness of the RoSCo preoperative risk scoring system, which incorporates the RENAL Nephrometry Score, the Charlson's Comorbidity Index, and body mass index to quantify surgical risk, in guiding individualized early mobilization protocols and to assess associated early postoperative recovery outcomes in patients undergoing robot-assisted partial nephrectomy (RAPN) for renal cell carcinoma (RCC). A prospective, randomized controlled study was conducted involving 82 patients diagnosed with RCC who underwent RAPN between October 2023 and October 2024 at the Department of Urology. Participants were randomized into an experimental group (n = 41) and a control group (n = 41). The experimental group received a RoSCo-guided personalized early mobility protocol, while the control group received conventional enhanced recovery after surgery care. Key postoperative recovery indicators, including time to first ambulation, time to first flatus and defecation, duration of hospital stay, and complication rates, were compared between the two groups. Participants in the experimental group demonstrated a significantly shorter time to first ambulation (18.94 ± 14.31 h) compared to the control group (36.56 ± 12.91 h, p < 0.001). The experimental group also exhibited significantly shorter postoperative hospital stays (5.34 ± 1.56 days vs 7.34 ± 2.98 days, p < 0.001), reduced duration of urinary catheterization (4.68 ± 1.94 days vs 6.00 ± 2.43 days, p = 0.008), earlier time to first flatus (19.99 ± 13.10 h vs 29.66 ± 23.82 h, p = 0.025), and earlier time to first defecation (65.12 ± 19.29 h vs 92.62 ± 39.98 h, p < 0.001). Additionally, the incidence of postoperative abdominal distension was significantly lower in the experimental group (2.44% vs 19.51%, p = 0.029). No statistically significant differences were observed between groups regarding the incidences of postoperative bleeding, urinary leakage, infection, lower back pain, or duration of drainage tube placement (p > 0.05). Preoperative risk stratification using the RoSCo score facilitates the development of personalized early mobilization protocols for patients undergoing RAPN for RCC. This approach is associated with improved early postoperative recovery outcomes, including earlier ambulation, faster gastrointestinal recovery, shorter hospitalization, and reduced catheterization duration, without increasing the risk of postoperative complications.