# Comparison of Mortality and Morbidity of Robotic Versus Laparoscopic Radical Nephrectomy for the Treatment of Renal Cell Carcinoma—An Analysis of the National Surgery Quality Improvement Program (NSQIP) Targeted Nephrectomy Database

## TL;DR

This study compares robotic and laparoscopic kidney cancer surgeries, finding similar major risks but differences in infection rates and recovery time.

## Contribution

The study provides a large-scale comparison of robotic and laparoscopic radical nephrectomy outcomes using a national database.

## Key findings

- Robotic surgery had lower surgical site infection rates compared to laparoscopic surgery.
- Laparoscopic surgery was associated with longer hospital stays and higher conversion to open surgery.
- Robotic surgery required longer operating times but showed no difference in major complications.

## Abstract

In patients with kidney cancer that exceeds 4 cm, radical nephrectomy is the mainstay of treatment. In our large-scale, multi-institutional study, we compared robotic-assisted radical nephrectomy vs. laparoscopic radical nephrectomy in the contemporary setting. We observed that although there were no differences in major complications (death, readmission, heart attack, or stroke), laparoscopic surgery was associated with an increased risk of surgical site infection, a prolonged length of stay, and an increased conversion rate to open surgery. We also found that robotic surgery is associated with an increased time in the operating room. However, while robotic-assisted surgery is associated with decreased complications, previous studies have shown that robotic-assisted surgery requires more monetary resources than laparoscopic. Overall, when choosing between conducting a radical nephrectomy in a robot-assisted manner or laparoscopically, surgeons should consider specific patient factors, the risk of perioperative complications, and incorporate value-based care.

Objectives: To compare the perioperative complications between robot-assisted (RARN) and laparoscopic (LRN) radical nephrectomy for the treatment of renal cell carcinoma (RCC). Methods: We conducted a retrospective study using the National Surgical Quality Improvement Program (NSQIP) Nephrectomy-Targeted database from 2019 to 2021. After using propensity score matching, we assessed the association between LRN vs. RARN and the outcomes of interest (primary outcomes of 30-day mortality, return to the operating room, myocardial infarction, and stroke; and secondary outcomes of perioperative complications and nephrectomy-specific outcomes). Results: Among the 1545 patients in the study (mean age: 62.9 ± 11.8 years), 722 underwent RARN and 823 underwent LRN. We did not observe any differences in the major complications between the two approaches. However, LRN was associated with an increased chance of surgical site infections compared with RARN (LRN 2.68% vs. RARN 1.19%, p = 0.047). LRN was also associated with a higher likelihood of a prolonged length of stay (OR 1.54, 95% CI: 1.15, 2.06, p = 0.004) and had a 2.7 times higher chance of conversion rate to open surgery (OR 3.70, 95% CI: 3.25, 4.15, p < 0.001) relative to RARN. However, RARN was associated with a longer operative time than LRN (estimated coefficient 30.67, p < 0.001). Conclusion: We found no significant difference in the major complications between RARN and LRN for patients undergoing radical nephrectomy. At the expense of a somewhat longer operative time, RARN was associated with a lower risk of SSI and a lower conversion rate to open RN. LRN and RARN should both be considered and selected on an individualized basis using tumor, patient, and physician factors.