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<p>Partial nephrectomy is the gold standard for clinical stage T1 renal masses when technically feasible. However, real-world adoption may vary according to access to robotic platforms and organizational factors. Multicenter retrospective comparative study using the Spanish National Registry of Localized Renal Cancer during 2024 (30 hospitals). A total of 891 cases were included in the robotic versus laparoscopy/open analysis and 1121 in the dedicated-team analysis. Adults with radiologic cT1 renal masses treated with scheduled surgery and malignant histology were included. Comparisons were robotic-assisted versus laparoscopy/open approaches, and centers with a dedicated kidney surgery team versus those without it. The primary endpoint was the rate of partial nephrectomy (PN) versus radical nephrectomy (RN), analyzed overall T1 and stratified by cT1a/cT1b. Secondary endpoints (among PNs) included ischemia use and ischemia time, and recorded reasons for not performing PN grouped as technical infeasibility versus other reasons. In unadjusted analyses, PN was performed more frequently in the robotic cohort than in the laparoscopy/open cohort for cT1 (88.4% vs. 56.4%, <i>p</i> &lt; 0.001), cT1a (90.2% vs. 68.7%, <i>p</i> &lt; 0.001), and cT1b (84.5% vs. 32.5%, <i>p</i> &lt; 0.001). Ischemia use was similar overall, while ischemia time was shorter in cT1a robotic cases (median 15 vs. 18&#xa0;min, <i>p</i> = 0.031). Dedicated-team centers did not show higher PN rates after substage stratification; however, technical infeasibility was less frequently recorded than in non-dedicated centers (45.9% vs. 75.7%, <i>p</i> &lt; 0.001). Access to robotic-assisted surgery was associated with markedly higher utilization of PN for cT1 renal masses—especially in cT1b tumors, though residual confounding cannot be excluded given the observational design. Dedicated kidney surgery teams were not associated with higher PN rates after stratification but were associated with fewer cases recorded as technical infeasibility.</p>

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Impact of robotic access and dedicated kidney surgery teams on nephron-sparing surgery for T1 renal masses: evidence from a Spanish multicenter registry

  • 期刊论文

  • 发表日期：

    2026年7月20日

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  • Itzhak Testa,
  • Daniel Pérez-Fentes,
  • Inmaculada Bravo,
  • Mario de Arriba,
  • Roberto Ballestero,
  • Miriam Serrano,
  • Estíbaliz Jiménez,
  • Javier Casas,
  • Paula Inza,
  • Cristina Flores,
  • Francisco Campanario,
  • Alberto López,
  • Mónica Sanz,
  • Rocio Barrabino,
  • Vital Hevia-Palacios,
  • Sergio Fernández-Pello

摘要

Partial nephrectomy is the gold standard for clinical stage T1 renal masses when technically feasible. However, real-world adoption may vary according to access to robotic platforms and organizational factors. Multicenter retrospective comparative study using the Spanish National Registry of Localized Renal Cancer during 2024 (30 hospitals). A total of 891 cases were included in the robotic versus laparoscopy/open analysis and 1121 in the dedicated-team analysis. Adults with radiologic cT1 renal masses treated with scheduled surgery and malignant histology were included. Comparisons were robotic-assisted versus laparoscopy/open approaches, and centers with a dedicated kidney surgery team versus those without it. The primary endpoint was the rate of partial nephrectomy (PN) versus radical nephrectomy (RN), analyzed overall T1 and stratified by cT1a/cT1b. Secondary endpoints (among PNs) included ischemia use and ischemia time, and recorded reasons for not performing PN grouped as technical infeasibility versus other reasons. In unadjusted analyses, PN was performed more frequently in the robotic cohort than in the laparoscopy/open cohort for cT1 (88.4% vs. 56.4%, p < 0.001), cT1a (90.2% vs. 68.7%, p < 0.001), and cT1b (84.5% vs. 32.5%, p < 0.001). Ischemia use was similar overall, while ischemia time was shorter in cT1a robotic cases (median 15 vs. 18 min, p = 0.031). Dedicated-team centers did not show higher PN rates after substage stratification; however, technical infeasibility was less frequently recorded than in non-dedicated centers (45.9% vs. 75.7%, p < 0.001). Access to robotic-assisted surgery was associated with markedly higher utilization of PN for cT1 renal masses—especially in cT1b tumors, though residual confounding cannot be excluded given the observational design. Dedicated kidney surgery teams were not associated with higher PN rates after stratification but were associated with fewer cases recorded as technical infeasibility.