Background Compared to traditional laparoscopic radical nephrectomy (LRN), robotic surgery offers potential advantages such as improved surgical dexterity and enhanced anatomical visualization during surgery, which can improve dissection, tumor identification, and control of renal vessels, aspects critical for reconstructive surgery. It is unclear whether these potential benefits would translate to improved post-operative outcomes for patients undergoing radical nephrectomy; thus, our objective was to compare perioperative complications

Methods We conducted a retrospective study using data from the American College of Surgeons-National Surgical Quality Improvement Program (ACS-NSQIP) Nephrectomy-Targeted database from 2019 to 2021, restricted to localized RCC. We utilized propensity score matching (1:1 PSM) to balance patient characteristics between the two groups. The association between the outcomes of interest (Primary Outcome as major complications within 30 days of surgery, including 30-day mortality, return to the operating room, cardiac arrest, MI, and CVA; Secondary outcome as other perioperative complications) and the operative modality was assessed using logistic regression.

Results Among the 1,545 patients in the study (mean age: 62.9±11.8 years), 722 underwent RARN and 823 underwent LRN. We did not observe any differences in major complications OR 0.93 (95% CI 0.43-2.00), p=0.848, including 30-day mortality, return rate to the operating room, cardiac arrest, myocardial infarction, and stroke or cerebrovascular accident between the operative modalities. LRN was associated with a 128% increased risk of surgical site infection OR 2.28 (95% CI 1.01-5.16), p=0.047 and 54% increased risk of prolonged LOS (defined as >3 days) [OR 1.54 (95% CI 1.15-2.06), p=0.004), compared to RARN group. In addition, the conversion rate of LRN to open RN was 4.3%, while the conversion rate of RARN was 1.16% OR 3.70 (3.25-4.15), p<0.001. RARN was associated with significantly longer operative time (minutes) than LRN Estimated coefficient: 30.67 (95% CI 23.15-38.18), p<0.001.

Conclusion We found no significant difference in major complications between RARN and LRN for patients undergoing surgery for localized kidney cancer. At the expense of somewhat longer operative time, RARN was associated with a lower risk of SSI and lower conversion rate to open RN. These data support the notion that LRN and RARN should both be considered and selected on an individualized basis using tumor, patient, and physician factors.