ORIGINAL ARTICLE   Free access

Minerva Urology and Nephrology 2024 April;76(2):185-94

DOI: 10.23736/S2724-6051.24.05692-1

Copyright © 2024 EDIZIONI MINERVA MEDICA

language: English

Minimally invasive transperitoneal partial versus radical nephrectomy in obese patients: perioperative and long-term functional outcomes from a large perspective contemporary series (RECORd2 project)

Luca LAMBERTINI ¹, Andrea MARI ¹, Alessandro SANDULLI ¹, Daniele AMPARORE ², Alessandro ANTONELLI ³, Maurizio BARALE ⁴, Pierluigi BOVE ⁵, Eugenio BRUNOCILLA ⁶, Umberto CAPITANIO ⁷, Luigi F. DA POZZO ^{8, 9}, Fabrizio DI MAIDA ¹, Antonio Andrea GROSSO ¹, Cristian FIORI ², Paolo GONTERO ⁴, Vincenzo LI MARZI ¹⁰, Riccardo CAMPI ¹⁰, Nicola LONGO ¹¹, Michele MARCHIONI ¹², Emanuele MONTANARI ¹³, Francesco MONTORSI ⁷, Francesco PORPIGLIA ², Angelo PORRECA ^{14, 15}, Riccardo SCHIAVINA ⁶, Claudio SIMEONE ¹⁶, Salvatore SIRACUSANO ³, Carlo TERRONE ¹⁷, Vincenzo FICARRA ¹⁸, Andrea MINERVINI ¹ ✉

¹ Department of Urology, Unit of Oncologic Minimally-Invasive Urology and Andrology, University of Florence, Careggi Hospital, Florence, Italy; ² Division of Urology, Department of Oncology, San Luigi Gonzaga Hospital, School of Medicine, Orbassano, Turin, Italy; ³ Department of Urology, Azienda Ospedaliera Universitaria Integrata (A.O.U.I.), Verona, Italy; ⁴ Division of Urology, Department of Surgical Sciences, San Giovanni Battista Hospital, University of Turin, Turin, Italy; ⁵ Department of Urology, University Hospital of Tor Vergata, Rome, Italy; ⁶ Department of Urology, University of Bologna, Bologna, Italy; Department of Experimental, Diagnostic, and Specialty Medicine, University of Bologna, Bologna, Italy; ⁷ Division of Experimental Oncology, Unit of Urology, Urological Research Institute, IRCCS San Raffaele Hospital, University Vita-Salute San Raffaele, Milan, Italy; ⁸ Department of Urology, Papa Giovanni XXIII Hospital, Bergamo, Italy; ⁹ Medicine and Surgery Department, University of Milano-Bicocca, Monza, Italy; ¹⁰ Department of Urology, Unit of Urological Minimally Invasive Robotic Surgery and Renal Transplantation, University of Florence, Careggi Hospital, Florence, Italy; ¹¹ Department of Urology, Federico II University, Naples, Italy; ¹² Department of Urology, SS Annunziata Hospital, Chieti, Italy; ¹³ Department of Urology, Fondazione IRCCS Ca’ Granda, Maggiore Polyclinic Hospital, University of Milan, Milan, Italy; ¹⁴ Veneto Institute of Oncology (IOV) IRCCS, Castelfranco Veneto, Treviso, Italy; ¹⁵ Department of Urology, Abano Terme Polyclinic, Abano Terme, Padua, Italy; ¹⁶ Department of Urology, Ospedali Civili, University of Brescia, Brescia, Italy; ¹⁷ Department of Urology, University of Genoa, Genoa, Italy; ¹⁸ Section of Urology, Department of Human and Pediatric Pathology, University of Messina, Messina, Italy

BACKGROUND: The aim of this study is to evaluate the perioperative and long-term functional outcomes of laparoscopic (LPN) and robot-assisted partial nephrectomy (RAPN) in comparison to laparoscopic radical nephrectomy (LRN) in obese patients diagnosed with renal cell carcinoma.
METHODS: Clinical data of 4325 consecutive patients from The Italian REgistry of COnservative and Radical Surgery for cortical renal tumor Disease (RECORD 2 Project) were gathered. Only patients treated with transperitoneal LPN, RAPN, or LRN with Body Mass Index (BMI) ≥30 kg/m², clinical T1 renal tumor and preoperative estimated glomerular filtration rate (eGFR) ≥60 mL/min, were included. Perioperative, and long-term functional outcomes were examined.
RESULTS: Overall, 388 patients were included, of these 123 (31.7%), 120 (30.9%) and 145 (37.4%) patients were treated with LRN, LPN, and RAPN, respectively. No significant difference was observed in preoperative characteristics. Overall, intra and postoperative complication rates were comparable among the groups. The LRN group had a significantly increased occurrence of acute kidney injury (AKI) compared to LPN and RAPN (40.6% vs. 15.3% vs. 7.6%, P=0.001). Laparoscopic RN showed a statistically significant higher renal function decline at 60-month follow-up assessment compared to LPN and RAPN. A significant renal function loss was recorded in 30.1% of patients treated with LRN compared to 16.7% and 10.3% of patients treated with LPN and RAPN (P=0.01).
CONCLUSIONS: In obese patients, both LPN and RAPN showcased comparable complication rates and higher renal function preservation than LRN. These findings highlighted the potential benefits of minimally invasive PN over radical surgery in the context of obese individuals.

KEY WORDS: Kidney neoplasms; Nephrectomy; Minimally invasive surgical procedures; Obesity