Trifecta Outcomes in Renal Hilar Tumors: A Comparison Between Robotic and Open Partial Nephrectomy

Objectives: To report a comparative analysis of outcomes in patients who underwent excisions of renal hilar tumors using both open and robotic approaches. Materials and Methods: We retrospectively reviewed robotic and open patients who underwent partial nephrectomy of renal hilar tumors between 2011 and 2016. Trifecta was defined as negative surgical margins, no complications, and a glomerular filtration rate (GFR) preservation of 90% at last follow-up. Inverse probability of treatment weighting (IPTW) was applied to equilibrate treatment groups, minimize selection bias, and optimize inference on the basis of each patient's clinicodemographic characteristics. Results: One hundred robotic and 64 open patients had sufficient data for IPTW. After weighting, there were no statistical differences in baseline characteristics between the two groups (p<0.05). On adjusted analyses, robotic partial nephrectomy (RPN) achieved equivalent rates of trifecta to open surgery (21.1% vs 13.9%, respectively, p=0.387). There were no differences between robotic and open cohorts for negative margin rates (72.8% vs 90.4%, p=0.124), absence of complications (68.6% vs 75.2%, p=0.587), or GFR 90% (39.4% vs 21.6%, p=0.111). The robotic cohort had a shorter mean length of stay (3.8 vs 5.0 days, p=0.012), and no difference in estimated blood loss (253.3 vs 357.1, p=0.091) or operating time (199.8 vs 200.4, p=0.961). Conclusions: In our analysis both open and RPN for hilar tumors were equally likely to achieve a low trifecta outcome with a shorter mean length of stay in the robotic cohort.