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Lower incidence of postoperative acute kidney injury in robot-assisted partial nephrectomy than in open partial nephrectomy: A propensity score-matched study.

BACKGROUND
Acute kidney injury (AKI) after partial nephrectomy is attributed to parenchymal reduction and ischemia, but the extent of its effect remains unclear. This study aimed to compare the incidence of postoperative AKI among robot-assisted partial nephrectomy (RAPN), laparoscopic partial nephrectomy (LPN), and open partial nephrectomy (OPN) and to evaluate the validity of RAPN by comparing it with LPN and OPN in terms of postoperative AKI, perioperative complications, and long-term renal function.


METHODS
Patients who underwent RAPN, LPN, and OPN for renal tumors at our institutions between 2004 and 2018 were retrospectively analyzed. RAPN and LPN were performed under warm ischemia and OPN under cold ischemia. En bloc hilar clamping was employed for LPN and OPN and arterial clamping for RAPN. AKI was defined as %decrease to nadir estimated glomerular filtration rate (eGFR) ≥25%. Multivariate regression analysis was used to test associations of AKI with perioperative factors. Then, we compared the incidence of AKI with two propensity-score-matched cohorts: RAPN vs. OPN and RAPN vs. LPN.


RESULTS
This study included 1,762 cases (RAPN: 959, LPN: 215, OPN: 588). After matching, 147 cases from RAPN and LPN groups each and 368 cases from RAPN and OPN groups each were selected. RAPN had shorter warm ischemia time than LPN, lower incidence of AKI, and lower %decrease in eGFR after 6 months. RAPN had a shorter ischemia time and a lower incidence of AKI than OPN, although the %decrease in eGFR after 6 months did not differ significantly.


CONCLUSION
AKI incidence was lower in RAPN than in LPN or OPN, which may be due to the shorter ischemia time or clamping only arteries in RAPN. Although long-term renal outcomes did not differ between RAPN and OPN, RAPN can help prevent AKI. This supports the validity of RAPN for patients with chronic kidney disease.