Abstract
Our objective was to investigate the long-term functional outcomes of robot-assisted partial nephrectomy combined with three-dimensional images, which were reconstructed using computed tomography images. The demographic, oncological, functional, and volumetric outcomes of 296 patients who underwent robot-assisted partial nephrectomy with and without three-dimensional images between 2013 and 2021 were analyzed retrospectively. Propensity score matching (1:1) was performed to adjust for potential baseline confounders. After matching, 71 patients were allocated to each group. A notable positive trend was observed with increased surgical experience in the three-dimensional robot-assisted partial nephrectomy group for WIT (p = 0.001), parenchymal preservation rate (p < 0.001), split renal function preservation rate on the operated kidney (p = 0.01), and eGFR preservation rate at 12 months (p = 0.021). In addition, functional outcomes (estimated glomerular filtration preservation rate (88.0 vs. 91.6%, P = 0.006), the number of patients with chronic kidney disease upgrading (26 vs. 13, P = 0.023), split renal function preservation rate (operated kidney: 84.9 vs. 88.5%, P = 0.015)) were significantly improved. The three-dimensional robot-assisted partial nephrectomy group was superior in terms of > 90% estimated glomerular filtration preservation (P = 0.010), chronic kidney disease upgrading free survival rates (P < 0.001), and volumetric outcomes (parenchyma volume preservation rate; 81.6 vs. 88.8%, P = 0.006). Three-dimensional images were positively associated with estimated glomerular filtration preservation (P = 0.023, odds ratio: 2.34) and prevention of upstaging chronic kidney disease (P = 0.013, odds ratio: 2.90). In this study, robot-assisted partial nephrectomy combined with three-dimensional images underscored the preservation of eGFR > 90% and the prevention of chronic kidney disease upgrading by improving the preservation rate of renal parenchyma and split renal function.