Propensity-Score-Based Comparative Analysis of Transperitoneal and Retroperitoneal Approaches in Open and Minimally Invasive Renal Surgery: Impact on Operative Outcomes.

Introduction: Renal cancer is among the ten most common cancers in western societies, with renal cell carcinoma (RCC) accounting for 95% of malignant renal neoplasms. Recent advances in surgical techniques and approaches have expanded treatment options, necessitating an evaluation of optimal approaches.

Methods: A retrospective, propensity-matched cohort with 814 patients (1999-2021) was conducted comparing open and minimally invasive (laparoscopic and robotic-assisted) nephrectomy and partial nephrectomy techniques, focusing on operative time, blood loss, hospital stay, complications, and perioperative complications.

Results: The retroperitoneal (RP) approach demonstrated shorter operation times, reduced blood loss, and quicker recovery compared to the transperitoneal (TP) approach. Minimal invasive techniques, whether laparoscopic or robotic, had shorter hospital stays, fewer complications and better postoperative renal function. The RP approach showed advantages in operative efficiency and reduced postoperative morbidity.

Conclusion: The findings support that the RP approach is at least as effective as, or superior to, the TP approach in terms of perioperative outcomes. Minimally invasive approaches, including robotic-assisted and laparoscopic techniques, are associated with improved recovery and fewer complications, highlighting their advantages in the surgical treatment of renal tumors. Further studies are needed to assess long-term oncologic and functional outcomes. These findings underline the importance of tailored surgical planning to optimize patient outcomes.