Comparison of laparoscopic and robot-assisted partial nephrectomy for intermediate/high-complexity endophytic renal tumors (R.E.N.A.L.-NS ≥ 7): a propensity score-matched retrospective study

PURPOSE: To compare operative, functional, and oncological outcomes between laparoscopic partial nephrectomy (LPN) and robot-assisted partial nephrectomy (RAPN) for intermediate/high-complexity (R.E.N.A.L. nephrometry score ≥ 7) endophytic renal tumors (ERTs) by propensity score matching (PSM) analysis. METHODS: We retrospectively analyzed data from 191 patients who underwent LPN (n = 120) or RAPN (n = 71) between June 2011 and June 2021. PSM was performed in a 1:1 ratio to balance preoperative characteristics, resulting in 70 matched pairs. Operative, functional, and oncological outcomes were then compared. Univariate and multivariate logistic regression identified factors associated with a trifecta and pentafecta failure, and Kaplan-Meier survival analysis compared survival outcomes. RESULTS: RAPN was associated with shorter median warm ischemia time (23.5 vs. 27.5 min, P < 0.001), higher trifecta achievement (60% vs. 30%, P < 0.001), and less eGFR decline at 48 h postoperatively (14.9 vs. 21.0 mL/min/1.73 m², P = 0.011) compared to LPN. There were no significant differences in other perioperative or pathology outcomes, and long-term renal function and survival outcomes were similar between the two groups. High complexity (R.E.N.A.L. nephrometry score range of 10 to 12) was an independent risk factor for trifecta (OR = 2.65; 95% CI, 1.16-6.07, P = 0.021) and pentafecta (OR = 2.65; 95% CI, 1.06-6.67, p = 0.038) failures. LPN was also an independent risk factor for trifecta failure (OR = 4.53; 95% CI, 2.11-9.76, P < 0.001) but not for pentafecta failure. CONCLUSION: RAPN demonstrates better efficacy than LPN in protecting short-term renal function and achieving trifecta, while maintaining comparable long-term outcomes in intermediate/high-complexity ERTs. The high complexity was a significant independent risk factor for failing to achieve both trifecta and pentafecta.