Robotic vs. open partial cytoreductive nephrectomy in metastatic renal cell carcinoma: adverse in-hospital outcomes

Objective: To test for adverse in-hospital outcomes after robotic (RPCN) vs. open partial cytoreductive nephrectomy (OPCN). Methods: RPCN and OPCN patients were retrospectively identified within the National Inpatient Sample database (2008–2019). Propensity score matching (PSM, ratio 1:2) and multivariable logistic regression models (LRM) were used. Results: Of 491 patients, 139 (28%) underwent RPCN vs. 352 (72%) OPCN. RPCN-rate increased from 4.2 to 42.5% over time (p < 0.001). RPCN patients exhibited similar age, comorbidity and race/ethnicity distribution relative to their OPCN counterparts. After 1:2 PSM, all 139 RPCN and 278 of 352 (79%) OPCN patients were included. Relative to OPCN, RPCN patients exhibited lower rates in four of 10 examined adverse in-hospital outcomes: intraoperative complications (< 3 vs. 9%, p = 0.02), pulmonary complications (6 vs. 14%, p = 0.02), blood transfusions (< 5 vs. 14%, p = 0.004) and exhibited shorter median length of stay (2 vs. 4 days, p < 0.001). In multivariable LRMs, RPCN independently predicted lower rates in the same four of 10 categories with odds ratio (OR) ranging from 0.17 to 0.34. Largest magnitude was recorded in shorter length of stay (OR 0.17, p < 0.001), followed by intraoperative complications (OR 0.24, p = 0.02), use of blood transfusions (OR 0.25, p = 0.003) and pulmonary complications (OR 0.34, p = 0.01). No differences in in-hospital mortality were recorded. Conclusion: Rates of RPCN has increased exponentially over time (4.2 to 42.5%). Relative to OPCN, RPCN is associated with fewer adverse in-hospital outcomes and shorter hospital stay. However, no differences regarding in-hospital mortality were recorded between RPCN and OPCN.