Robotic versus laparoscopic radical nephrectomy

a large multi-institutional analysis (ROSULA Collaborative Group)

Uzoma A. Anele, Michele Marchioni, Bo Yang, Giuseppe Simone, Robert G. Uzzo, Clayton Lau, Maria C. Mir, Umberto Capitanio, James Porter, Ken Jacobsohn, Nicolo de Luyk, Andrea Mari, Kidon Chang, Cristian Fiori, Jay Sulek, Alexandre Mottrie, Wesley White, Sisto Perdona, Giuseppe Quarto, Ahmet Bindayi & 21 others Akbar Ashrafi, Luigi Schips, Francesco Berardinelli, Chao Zhang, Michele Gallucci, Miguel Ramirez-Backhaus, Alessandro Larcher, Patrick Kilday, Michael Liao, Peter Langenstroer, Prokar Dasgupta, Ben Challacombe, Alexander Kutikov, Andrea Minervini, KoonHo Rha, Chandru P. Sundaram, Lance J. Hampton, Francesco Porpiglia, Monish Aron, Ithaar Derweesh, Riccardo Autorino

Research output: Contribution to journalArticle

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Abstract

Objective: To compare the outcomes of robotic radical nephrectomy (RRN) to those of laparoscopic radical nephrectomy (LRN) for large renal masses. Methods: This was a retrospective analysis of RRN and LRN cases performed for large (≥ cT2) renal masses from 2004 to 2017 and collected in the multi-institutional international database (ROSULA: RObotic SUrgery for LArge renal masses). Peri-operative, functional, and oncologic outcomes were compared between each approach. Descriptive analyses were performed and presented as medians with interquartile ranges. Inverse probability of treatment weighting-adjusted multivariable analyses were used to identify predictors of peri-operative complications. Kaplan–Meier analysis and Cox regression models were used to assess survival outcomes. Results: A total of 941 patients (RRN = 404, LRN = 537) were identified. There was no difference in terms of gender, age, and clinical tumor size. Over the study period, RRN had an annual increase of 11.75% (95% CI [7.34, 17.01] p < 0.001) and LRN had an annual decline of 5.39% (95% CI [−6.94, −3.86] p < 0.001). Patients undergoing RRN had higher BMI (27.6 [IQR 24.8–31.1] vs. 26.5 [24.1–30.0] kg/m 2 , p < 0.01). Operative duration was longer for RRN (185.0 [150.0–237.2] vs. 126 [90.8–180.0] min, p < 0.001). Length of stay was shorter for RRN (3.0 [2.0–4.0] vs. 5.0 [4.0–7.0] days, p < 0.001). RRN cases presented more advanced disease (higher pathologic staging [pT3–4 52.5 vs. 24.2%, p < 0.001], histologic grade [high grade 49.3 vs. 30.4%, p < 0.001], and rate of nodal disease [pN1 5.4 vs. 1.9%, p < 0.01]). Surgical approach did not represent an independent risk factor for peri-operative complications (OR 1.81 95% CI [0.97–3.39], adjusted p = 0.2). The main study limitation is the retrospective design. Conclusions: This study represents the largest known multi-center comparison between RRN and LRN. The two procedures seem to offer similar peri-operative outcomes. Notably, RRN has been increasingly utilized, especially in the setting of more advanced and surgically challenging disease without increasing the risk of peri-operative complications.

Original languageEnglish
JournalWorld Journal of Urology
DOIs
Publication statusPublished - 2019 Jan 1

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Robotics
Nephrectomy
Kidney
Proportional Hazards Models
Length of Stay
Regression Analysis
Databases

All Science Journal Classification (ASJC) codes

  • Urology

Cite this

Anele, Uzoma A. ; Marchioni, Michele ; Yang, Bo ; Simone, Giuseppe ; Uzzo, Robert G. ; Lau, Clayton ; Mir, Maria C. ; Capitanio, Umberto ; Porter, James ; Jacobsohn, Ken ; de Luyk, Nicolo ; Mari, Andrea ; Chang, Kidon ; Fiori, Cristian ; Sulek, Jay ; Mottrie, Alexandre ; White, Wesley ; Perdona, Sisto ; Quarto, Giuseppe ; Bindayi, Ahmet ; Ashrafi, Akbar ; Schips, Luigi ; Berardinelli, Francesco ; Zhang, Chao ; Gallucci, Michele ; Ramirez-Backhaus, Miguel ; Larcher, Alessandro ; Kilday, Patrick ; Liao, Michael ; Langenstroer, Peter ; Dasgupta, Prokar ; Challacombe, Ben ; Kutikov, Alexander ; Minervini, Andrea ; Rha, KoonHo ; Sundaram, Chandru P. ; Hampton, Lance J. ; Porpiglia, Francesco ; Aron, Monish ; Derweesh, Ithaar ; Autorino, Riccardo. / Robotic versus laparoscopic radical nephrectomy : a large multi-institutional analysis (ROSULA Collaborative Group). In: World Journal of Urology. 2019.
@article{d28071239aa243539da07111cbc67262,
title = "Robotic versus laparoscopic radical nephrectomy: a large multi-institutional analysis (ROSULA Collaborative Group)",
abstract = "Objective: To compare the outcomes of robotic radical nephrectomy (RRN) to those of laparoscopic radical nephrectomy (LRN) for large renal masses. Methods: This was a retrospective analysis of RRN and LRN cases performed for large (≥ cT2) renal masses from 2004 to 2017 and collected in the multi-institutional international database (ROSULA: RObotic SUrgery for LArge renal masses). Peri-operative, functional, and oncologic outcomes were compared between each approach. Descriptive analyses were performed and presented as medians with interquartile ranges. Inverse probability of treatment weighting-adjusted multivariable analyses were used to identify predictors of peri-operative complications. Kaplan–Meier analysis and Cox regression models were used to assess survival outcomes. Results: A total of 941 patients (RRN = 404, LRN = 537) were identified. There was no difference in terms of gender, age, and clinical tumor size. Over the study period, RRN had an annual increase of 11.75{\%} (95{\%} CI [7.34, 17.01] p < 0.001) and LRN had an annual decline of 5.39{\%} (95{\%} CI [−6.94, −3.86] p < 0.001). Patients undergoing RRN had higher BMI (27.6 [IQR 24.8–31.1] vs. 26.5 [24.1–30.0] kg/m 2 , p < 0.01). Operative duration was longer for RRN (185.0 [150.0–237.2] vs. 126 [90.8–180.0] min, p < 0.001). Length of stay was shorter for RRN (3.0 [2.0–4.0] vs. 5.0 [4.0–7.0] days, p < 0.001). RRN cases presented more advanced disease (higher pathologic staging [pT3–4 52.5 vs. 24.2{\%}, p < 0.001], histologic grade [high grade 49.3 vs. 30.4{\%}, p < 0.001], and rate of nodal disease [pN1 5.4 vs. 1.9{\%}, p < 0.01]). Surgical approach did not represent an independent risk factor for peri-operative complications (OR 1.81 95{\%} CI [0.97–3.39], adjusted p = 0.2). The main study limitation is the retrospective design. Conclusions: This study represents the largest known multi-center comparison between RRN and LRN. The two procedures seem to offer similar peri-operative outcomes. Notably, RRN has been increasingly utilized, especially in the setting of more advanced and surgically challenging disease without increasing the risk of peri-operative complications.",
author = "Anele, {Uzoma A.} and Michele Marchioni and Bo Yang and Giuseppe Simone and Uzzo, {Robert G.} and Clayton Lau and Mir, {Maria C.} and Umberto Capitanio and James Porter and Ken Jacobsohn and {de Luyk}, Nicolo and Andrea Mari and Kidon Chang and Cristian Fiori and Jay Sulek and Alexandre Mottrie and Wesley White and Sisto Perdona and Giuseppe Quarto and Ahmet Bindayi and Akbar Ashrafi and Luigi Schips and Francesco Berardinelli and Chao Zhang and Michele Gallucci and Miguel Ramirez-Backhaus and Alessandro Larcher and Patrick Kilday and Michael Liao and Peter Langenstroer and Prokar Dasgupta and Ben Challacombe and Alexander Kutikov and Andrea Minervini and KoonHo Rha and Sundaram, {Chandru P.} and Hampton, {Lance J.} and Francesco Porpiglia and Monish Aron and Ithaar Derweesh and Riccardo Autorino",
year = "2019",
month = "1",
day = "1",
doi = "10.1007/s00345-019-02657-2",
language = "English",
journal = "World Journal of Urology",
issn = "0724-4983",
publisher = "Springer Verlag",

}

Anele, UA, Marchioni, M, Yang, B, Simone, G, Uzzo, RG, Lau, C, Mir, MC, Capitanio, U, Porter, J, Jacobsohn, K, de Luyk, N, Mari, A, Chang, K, Fiori, C, Sulek, J, Mottrie, A, White, W, Perdona, S, Quarto, G, Bindayi, A, Ashrafi, A, Schips, L, Berardinelli, F, Zhang, C, Gallucci, M, Ramirez-Backhaus, M, Larcher, A, Kilday, P, Liao, M, Langenstroer, P, Dasgupta, P, Challacombe, B, Kutikov, A, Minervini, A, Rha, K, Sundaram, CP, Hampton, LJ, Porpiglia, F, Aron, M, Derweesh, I & Autorino, R 2019, 'Robotic versus laparoscopic radical nephrectomy: a large multi-institutional analysis (ROSULA Collaborative Group)', World Journal of Urology. https://doi.org/10.1007/s00345-019-02657-2

Robotic versus laparoscopic radical nephrectomy : a large multi-institutional analysis (ROSULA Collaborative Group). / Anele, Uzoma A.; Marchioni, Michele; Yang, Bo; Simone, Giuseppe; Uzzo, Robert G.; Lau, Clayton; Mir, Maria C.; Capitanio, Umberto; Porter, James; Jacobsohn, Ken; de Luyk, Nicolo; Mari, Andrea; Chang, Kidon; Fiori, Cristian; Sulek, Jay; Mottrie, Alexandre; White, Wesley; Perdona, Sisto; Quarto, Giuseppe; Bindayi, Ahmet; Ashrafi, Akbar; Schips, Luigi; Berardinelli, Francesco; Zhang, Chao; Gallucci, Michele; Ramirez-Backhaus, Miguel; Larcher, Alessandro; Kilday, Patrick; Liao, Michael; Langenstroer, Peter; Dasgupta, Prokar; Challacombe, Ben; Kutikov, Alexander; Minervini, Andrea; Rha, KoonHo; Sundaram, Chandru P.; Hampton, Lance J.; Porpiglia, Francesco; Aron, Monish; Derweesh, Ithaar; Autorino, Riccardo.

In: World Journal of Urology, 01.01.2019.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Robotic versus laparoscopic radical nephrectomy

T2 - a large multi-institutional analysis (ROSULA Collaborative Group)

AU - Anele, Uzoma A.

AU - Marchioni, Michele

AU - Yang, Bo

AU - Simone, Giuseppe

AU - Uzzo, Robert G.

AU - Lau, Clayton

AU - Mir, Maria C.

AU - Capitanio, Umberto

AU - Porter, James

AU - Jacobsohn, Ken

AU - de Luyk, Nicolo

AU - Mari, Andrea

AU - Chang, Kidon

AU - Fiori, Cristian

AU - Sulek, Jay

AU - Mottrie, Alexandre

AU - White, Wesley

AU - Perdona, Sisto

AU - Quarto, Giuseppe

AU - Bindayi, Ahmet

AU - Ashrafi, Akbar

AU - Schips, Luigi

AU - Berardinelli, Francesco

AU - Zhang, Chao

AU - Gallucci, Michele

AU - Ramirez-Backhaus, Miguel

AU - Larcher, Alessandro

AU - Kilday, Patrick

AU - Liao, Michael

AU - Langenstroer, Peter

AU - Dasgupta, Prokar

AU - Challacombe, Ben

AU - Kutikov, Alexander

AU - Minervini, Andrea

AU - Rha, KoonHo

AU - Sundaram, Chandru P.

AU - Hampton, Lance J.

AU - Porpiglia, Francesco

AU - Aron, Monish

AU - Derweesh, Ithaar

AU - Autorino, Riccardo

PY - 2019/1/1

Y1 - 2019/1/1

N2 - Objective: To compare the outcomes of robotic radical nephrectomy (RRN) to those of laparoscopic radical nephrectomy (LRN) for large renal masses. Methods: This was a retrospective analysis of RRN and LRN cases performed for large (≥ cT2) renal masses from 2004 to 2017 and collected in the multi-institutional international database (ROSULA: RObotic SUrgery for LArge renal masses). Peri-operative, functional, and oncologic outcomes were compared between each approach. Descriptive analyses were performed and presented as medians with interquartile ranges. Inverse probability of treatment weighting-adjusted multivariable analyses were used to identify predictors of peri-operative complications. Kaplan–Meier analysis and Cox regression models were used to assess survival outcomes. Results: A total of 941 patients (RRN = 404, LRN = 537) were identified. There was no difference in terms of gender, age, and clinical tumor size. Over the study period, RRN had an annual increase of 11.75% (95% CI [7.34, 17.01] p < 0.001) and LRN had an annual decline of 5.39% (95% CI [−6.94, −3.86] p < 0.001). Patients undergoing RRN had higher BMI (27.6 [IQR 24.8–31.1] vs. 26.5 [24.1–30.0] kg/m 2 , p < 0.01). Operative duration was longer for RRN (185.0 [150.0–237.2] vs. 126 [90.8–180.0] min, p < 0.001). Length of stay was shorter for RRN (3.0 [2.0–4.0] vs. 5.0 [4.0–7.0] days, p < 0.001). RRN cases presented more advanced disease (higher pathologic staging [pT3–4 52.5 vs. 24.2%, p < 0.001], histologic grade [high grade 49.3 vs. 30.4%, p < 0.001], and rate of nodal disease [pN1 5.4 vs. 1.9%, p < 0.01]). Surgical approach did not represent an independent risk factor for peri-operative complications (OR 1.81 95% CI [0.97–3.39], adjusted p = 0.2). The main study limitation is the retrospective design. Conclusions: This study represents the largest known multi-center comparison between RRN and LRN. The two procedures seem to offer similar peri-operative outcomes. Notably, RRN has been increasingly utilized, especially in the setting of more advanced and surgically challenging disease without increasing the risk of peri-operative complications.

AB - Objective: To compare the outcomes of robotic radical nephrectomy (RRN) to those of laparoscopic radical nephrectomy (LRN) for large renal masses. Methods: This was a retrospective analysis of RRN and LRN cases performed for large (≥ cT2) renal masses from 2004 to 2017 and collected in the multi-institutional international database (ROSULA: RObotic SUrgery for LArge renal masses). Peri-operative, functional, and oncologic outcomes were compared between each approach. Descriptive analyses were performed and presented as medians with interquartile ranges. Inverse probability of treatment weighting-adjusted multivariable analyses were used to identify predictors of peri-operative complications. Kaplan–Meier analysis and Cox regression models were used to assess survival outcomes. Results: A total of 941 patients (RRN = 404, LRN = 537) were identified. There was no difference in terms of gender, age, and clinical tumor size. Over the study period, RRN had an annual increase of 11.75% (95% CI [7.34, 17.01] p < 0.001) and LRN had an annual decline of 5.39% (95% CI [−6.94, −3.86] p < 0.001). Patients undergoing RRN had higher BMI (27.6 [IQR 24.8–31.1] vs. 26.5 [24.1–30.0] kg/m 2 , p < 0.01). Operative duration was longer for RRN (185.0 [150.0–237.2] vs. 126 [90.8–180.0] min, p < 0.001). Length of stay was shorter for RRN (3.0 [2.0–4.0] vs. 5.0 [4.0–7.0] days, p < 0.001). RRN cases presented more advanced disease (higher pathologic staging [pT3–4 52.5 vs. 24.2%, p < 0.001], histologic grade [high grade 49.3 vs. 30.4%, p < 0.001], and rate of nodal disease [pN1 5.4 vs. 1.9%, p < 0.01]). Surgical approach did not represent an independent risk factor for peri-operative complications (OR 1.81 95% CI [0.97–3.39], adjusted p = 0.2). The main study limitation is the retrospective design. Conclusions: This study represents the largest known multi-center comparison between RRN and LRN. The two procedures seem to offer similar peri-operative outcomes. Notably, RRN has been increasingly utilized, especially in the setting of more advanced and surgically challenging disease without increasing the risk of peri-operative complications.

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UR - http://www.scopus.com/inward/citedby.url?scp=85061335529&partnerID=8YFLogxK

U2 - 10.1007/s00345-019-02657-2

DO - 10.1007/s00345-019-02657-2

M3 - Article

JO - World Journal of Urology

JF - World Journal of Urology

SN - 0724-4983

ER -