Open versus robotic partial nephrectomy for organ-confined complex renal tumors: A seven-year retrospective study

: Objective Nephron-sparing surgeries have globally replaced radical nephrectomy in the management of localized renal tumors. The optimal approach to partial nephrectomy for complex renal tumors remains controversial. This study aimed to compare the surgical, functional, and oncological outcomes of open (OPN) and robotic partial nephrectomy (RPN) for organ-confined complex renal tumors. Methods This comparative study was conducted as a part of a joint supervision mission through the scientific channel between Assiut University, Egypt, and Tübingen University, Germany. The study collected data of patients ≥18 years old who underwent either OPN or RPN for a single organ-confined parenchymal renal tumor with R.E.N.A.L. score >7 at Department of Urology, University Hospital of Tübingen, from January 2016 to December 2022. The two approaches were compared before and after propensity score matching (PSM) in terms of preoperative criteria, operative details, and postoperative outcomes. The primary outcomes included the occurrence of major complications, early postoperative estimated glomerular filtration rate drop, and times to local recurrence and distant metastasis. Results Of the 166 included patients, OPN and RPN were performed in 122 (73.5%) and 44 (26.5%) patients, respectively. Before PSM, the RPN group had a smaller median tumor size and a lower R.E.N.A.L. score. PSM based upon tumor size, R.E.N.A.L. score, and body mass index yielded subgroups of 80 and 36 patients for OPN and RPN, respectively. The median estimated glomerular filtration rate drop was less after RPN (2.6 vs. 8.55 mL/min/1.73 m 2 ; p = 0.04), but the difference was statistically insignificant after matching (7 vs. 7.9 mL/min/1.73 m 2 ; p = 0.20). Complication rates and times to recurrence and metastasis were comparable between the two groups before and after matching. After matching, despite a longer median operative time (183 vs. 139 min; p < 0.01), RPN resulted in a lower median postoperative pain score (2 vs. 4; p < 0.01) and a shorter median hospital stay (6 vs. 7 d; p < 0.01). Conclusion RPN yields surgical and oncological outcomes similar to those of OPN, with the possibility of a better impact on early postoperative renal function in patients with organ-confined complex renal tumors.