Does the Surgical Technique Impact the Oncologic Outcomes after Partial Nephrectomy? A Comparison Between Open, Laparoscopic and Robotic Approach in a Single High-Volume Tertiary Center

INTRODUCTION AND OBJECTIVES: To compare the oncologic outcomes of patients who underwent Open partial nephrectomy (OPN), Laparoscopic partial nephrectomy (LPN) and Robotic partial nephrectomy (RPN) at mid-long term follow upMETHODS: Patients were stratified according to the surgical technique: OPN vs LPN vs RPN. Differences in categorical and continuous variables were analyzed using the chi-squared test and the Mann-Whitney U-test, respectively. Outcomes of interest: disease free survival (DFS) and cancer-specific survival (CSS) were plotted using Kaplan-Meier survival curves. The association between oncologic outcomes and clinicopathological features and techniques were assessed using a univariable and multivariable Cox proportional hazard model. RESULTS: Of 547 patients, 293 (54%), 153 (28%) and 101 (19%) underwent OPN, LPN and RPN, respectively. RPN was associated with high PADUA risk compared to OPN and LPN (19% vs 12% vs 10%; p=0.03), longer median operative time (218 min vs 130 min vs 136 min p<0.001). Patients in the OPN group had longer median follow-up compared to those in the LP and RPN groups (75 months vs 43 months vs 26 months; p<0.001) and higher recurrence rate (10% vs 6% vs 3%; p=0.048). A detailed list of clinicopathological characteristics and oncologic outcomes is reported in Table 1a. OPN was associated with higher cancer specific death compared to LP and RPN (4% vs 1% vs 1%; p=0.03). Main predictors of Local recurrence were high tumor grade (odds ratio OR= 19.3; 95% CI: 2.4-155; p=0.05) and PSM (OR=60.8; 95% CI:15-247; p<0.001). Main predictors of distant recurrence were intermediate/high PADUA risk (OR=4.2; 95% CI:1.4-12; p=0.007), pathologic stage >pT1 (OR=7.7; 95% CI:2.6-23.1; p<0.001) and high tumor grade (OR=8.4; 95% CI:2.7-25.9; p<0.001). Main predictor of CSS was high tumor grade (OR=4.2; 95% CI:1.2-4.3; p=0.02). The surgical technique didn’t affect the oncologic outcomes (Table 1b). CONCLUSIONS: OPN, LPN and RPN provides similar oncologic outcomes. DFS is mainly affected by high tumor grade and positive surgical margins Figure. No caption available. Figure. No caption available. Table. No title available. Source of Funding: none