Functional Outcomes of Robot-Assisted and Laparoscopic Partial Nephrectomy for cT1a and cT1b Renal Neoplasia with Low-Intermediate Tumor Complexity - Do Mass Localization, Ischemia, and Surgical Approach Matter?

Sep 29, 2026

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Background. Nephron-sparing surgery is the standard for treating cT1 renal neoplasms, with ongoing debate about how surgical technique affects long-term renal function, especially ischemic injury and warm ischemia time (WIT). “Residual vascularized parenchymal volume” has been proposed as a key determinant. This multicenter retrospective study evaluates how tumor localization and surgical approach (on-clamp vs off-clamp) influence renal functional recovery in patients undergoing robotic or laparoscopic partial nephrectomy for low-to-intermediate complexity tumors. Methods and outcomes assess creatinine and eGFR trends over baseline and up to 12 months. Results and conclusions compare techniques and define an ischemia threshold for comparable recovery.

LanguageEnglish

CategoryHealthcare

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Pages7

Reading Time18 min

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Background

Patients and Methods

Results

Conclusions

Keywords

Ann Surg Oncol (2026) 33:1878–1884 [https://doi.org/10.1245/s10434-025-18554-5](https://doi.org/10.1245/s10434-025-18554-5) ORIGINAL ARTICLE – UROLOGIC ONCOLOGY Functional Outcomes of Robot‑Assisted and Laparoscopic Partial Nephrectomy for cT1a and cT1b Renal Neoplasia with Low‑Intermediate Tumor Complexity: Do Mass Localization, Ischemia, and Surgical Approach Matter? Pier Paolo Prontera, MD1, Antonio Balestra, MD2, Marco Lattarulo, MD1, Gianluigi Califano, MD, PhD3, Francesco Di Bello, MD3, Claudia Collà Ruvolo, MD3, Simone Morra, MD3, Angelo Porreca, MD4, Luca Di Gianfrancesco, MD4, Arman Tsaturyan, MD5,6, Francesco Dibenedetto, MD, RN7, and Francesco S. Grossi, MD, PhD1 1Department of Urology, S.S. Annunziata Hospital, Taranto, Italy; 2Department of Urology, Hospital Valle D’Itria, Martina Franca, Italy; 3Department of Neurosciences, Reproductive and Odontostomatologic Sciences, University of Naples Federico II, Naples, Italy; 4Department of Urology, Humanitas Gavazzeni Hospital, Bergamo, Italy; 5Department of Urology, Yerevan State Medical University after Mkhitar, Heratsi, Yerevan, Armenia; 6Department of Urology Erebouni Medical Center, Yerevan, Armenia; 7Department of Operating Room, S.S. Annunziata Hospital, Taranto, Italy ABSTRACT Background. Nephron-sparing surgery is the gold standard for the treatment of cT1 renal neoplasms. The literature extensively debates the impact of various surgical techniques on long-term renal function, focusing particularly on ischemic damage and warm ischemia time (WIT) .“Residual vascularized parenchymal volume” has emerged as a key factor influencing renal function outcomes. This study investigates the role of tumor localization and surgical technique (on-clamp versus off-clamp) in renal functional recovery for patients with low-to-intermediate tumor complexity underwent both robotic and laparoscopic partial nephrectomy. Patients and Methods. A multicenter retrospective study was conducted on 100 patients with cT1a or cT1b renal tumors (RENAL score 4–9) who underwent robotic or laparoscopic partial nephrectomy between 2020 and 2024. Demographic, tumor, and perioperative data were collected. Trend of serum creatinine and estimated glomerular filtration rate (eGFR) was evaluated at baseline, immediately © The Author(s) 2025 First Received: 25 July 2025 Accepted: 27 September 2025 Published online: 28 October 2025 P. P. Prontera, MD[e-mail: pierpaolo.prontera@virgilio.it](e-mail: pierpaolo.prontera@virgilio.it); [pierpaolo.prontera@asl.taranto.it](pierpaolo.prontera@asl.taranto.it) postsurgery, and at 1, 3, 6, and 12 months. Statistical analysis was performed using Mann–Whitney U, chi-square, and Spearman’s rank correlation tests. Results. No significant differences in renal function were found between cT1a and cT1b tumors or between on-clamp and off-clamp techniques. The robotic and laparoscopic approaches also showed no significant difference in longterm renal outcomes. Conclusions. Tumor localization, ischemia type, and surgical approach did not significantly impact functional outcomes in low-to-intermediate complexity cT1 renal tumors. Comparable renal recovery was observed with both on-/ off-clamp and robotic/laparoscopic techniques, as long as ischemia remained under 30 min. In this setting, the ischemic strategy may be chosen to enhance visibility and maximize parenchymal preservation. Keywords Renal neoplasm · Partial nephrectomy · Warm ischemia time · Renal function · Robotic surgery · Laparoscopic surgery · Nephrometry score Renal tumor enucleation has emerged as the gold standard for the surgical treatment of cT1 renal neoplasms. In recent decades, the literature has extensively debated the impact of various surgical techniques on long-term renal functional outcomes, particularly focusing on the role of ischemic damage and the impact of warm ischemia time (WIT) and tumor complexity on residual renal function.1-5 There is general consensu

FAQs

What surgical procedures were compared in this study?

The study compared robotic versus laparoscopic partial nephrectomy and on-clamp versus off-clamp techniques in patients with cT1a or cT1b renal tumors.

Which renal function measures were evaluated, and when?

Serum creatinine and estimated glomerular filtration rate (eGFR) were assessed at baseline, immediately postsurgery, and at 1, 3, 6, and 12 months.

Did tumor type (cT1a vs cT1b) or clamp technique significantly change renal outcomes?

No significant differences in renal function were found between cT1a and cT1b tumors or between on-clamp and off-clamp approaches.

Under what condition did the authors observe comparable recovery across approaches?

Comparable renal recovery was observed across on-/off-clamp and robotic/laparoscopic techniques when ischemia remained under 30 minutes, suggesting ischemic strategy selection may prioritize visibility and parenchymal preservation.

Sep 29, 2026

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