Comparative Outcomes of Robot-assisted versus Open Radical Nephrectomy with IVC Thrombectomy in France: Insights from the Robocav Study (UroCCR 188)

BACKGROUND While robotic-assisted radical nephrectomy with IVC thrombectomy (R-CT) has emerged as a minimally invasive alternative to the open approach (O-CT), the latter remains the standard, with limited comparative studies. OBJECTIVE This study aimed to compare perioperative outcomes and oncological efficacy of R-CT versus O-CT based on the French multicenter experience. DESIGN, SETTING, AND PARTICIPANTS We conducted a retrospective, multicenter, propensity score-matched study using prospectively collected data from the UroCCR kidney cancer research network. Patients with Mayo level 1-2 thrombus who underwent O-CT or R-CT between December 2015 and July 2024 in eight tertiary centers were included. INTERVENTION Open or robotic-assisted radical nephrectomy with IVC thrombectomy. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS Propensity scores were estimated through a logistic model including demographic, clinical, and tumor-related variables. Matching was performed using optimal full matching and a 0.2 SD caliper. Treatment effects were estimated using linear, logistic, or Cox regression models and pooled across imputations according to Rubin's rules. The primary outcome was surgical morbidity, while secondary outcomes included surgical, oncological and functional outcomes. RESULTS AND LIMITATIONS After matching, 92 of the 94 included patients remained, including 57 open and 35 robotic cases. Lower estimated blood loss (median, 400 mL vs. 1300 mL; p=0.013) and global length of stay (median, 5 days vs. 8 days; p=0.008) were observed in the robotic group. There were no statistically significant differences in complications, oncological and functional outcomes. CONCLUSIONS In selected patients and expert centers, R-CT was associated with reduced blood loss and faster recovery compared to O-CT. PATIENT SUMMARY We compared two surgical techniques to remove kidney tumors that extend into the IVC. The robotic approach was associated with less blood loss and shorter hospital stays. Cancer control and kidney function were similar between both techniques.