Robotic‐assisted laparoscopic tumor enucleation is a feasible technique for renal hilar tumors: A retrospective study

Background and Objective This study aimed to evaluate the safety and efficacy of robot‐assisted laparoscopic tumor enucleation (RAE) for the treatment of renal hilar tumors and to describe our experience with renorrhaphy‐related surgical techniques. Methods Retrospective data were collected from 173 consecutive patients who underwent RAE for localized renal tumors (cT1–cT2N0M0) at our hospital between September 2014 and November 2019. Results Seventy‐five patients had renal hilar tumors and 98 patients had nonhilar tumors. There were no statistical differences between the hilar and nonhilar groups in operation time (190 [115–390] vs. 190 [110–390] min, p = 0.889), warm ischemia time (26 [12–60] vs. 27 [17–41] min, p = 0.257), hospital stay duration (8 [3–16] vs. 7.5 [4–18] days, p = 0.386), renal function (estimated glomerular filtration rate, 102.5 [29.4–144] vs. 101.3 [64.2–134.7] ml/min/1.73 m2, p = 0.631); creatinine level, (76 [43–169] vs. 78.5 [50–281.3] µmol/L, p = 0.673), perioperative complications rate, or surgical margin status. However, patients with hilar tumors lost significantly more blood than did those with nonhilar tumors (250 [50–1500] vs. 200 [20–1200] ml, p = 0.007). During the follow‐up period (median, 30 months), three patients in each group experienced recurrence. The 5‐year recurrence‐free rates were 93.0% and 95.4% in the hilar and nonhilar tumor groups, respectively (p = 0.640). Conclusions For experienced robot laparoscopists, RAE is a safe, effective, and feasible procedure for renal hilar tumors, without increased risk of positive surgical margins or worse midterm oncologic outcomes compared with nonhilar tumors. Highlights RAE is an alternative surgical method for renal hilar tumors. It does not increase the positive surgical margin and affect the mid‐term oncology outcome while retaining the normal renal parenchyma to the greatest extent. It seems to have more advantages in reducing postoperative complications.