Propensity-score matched oncological outcomes and patterns of recurrence following open and minimally-invasive partial nephrectomy for renal cell carcinoma

Background: Oncological equivalency of minimally-invasive partial nephrectomy compared to open partial nephrectomy (OPN) continues to be challenged by proponents of open urologic oncology surgery. Objective: To compare patterns of recurrence, recurrence-free survival, cancer-specific survival, and overall survival between patients who underwent open or minimally-invasive partial nephrectomy. Materials and Methods: Data from prospectively maintained databases from 2 urban quaternary referral centers was retrospectively collected from 2003 to 2018. Patients who underwent either open or minimally-invasive (laparoscopic or robotic-assisted) partial nephrectomy and found to have malignant pathology were included. The groups subsequently underwent propensity-score matching to ensure homogeneity prior to analysis. The primary outcomes were incidence of recurrence, time to recurrence, time from recurrence to death, location of recurrence, and recurrence-free survival. Secondary outcomes included overall survival and cancer-specific survival. Results: A total of 190 patients underwent OPN and 190 underwent minimally-invasive partial nephrectomy. Recurrence was more common in patients undergoing OPN (10% vs. 3.2%, P = 0.01), but surgical approach was not predictive of location of recurrence (P = 1) or time to recurrence (23.8 vs. 26.3 months, P = 0.73). All-cause mortality was more common in the OPN group (10.5% vs. 2.6%, P = 0.003). On multivariable analysis, only surgical approach was associated with increased risk for recurrence (OR 3.88, P = 0.009). Conclusion: This propensity-score matched analysis of patients undergoing partial nephrectomy suggests that minimally invasive surgical approach is resulted in decreased risk of recurrence and overall survival, and does not increase the risk for atypical sites of recurrence.