Robot-assisted radical nephrectomy in comparison with open and laparoscopic approaches: a Japanese single-institution retrospective study

To appraise perioperative metrics and oncologic results for robot-assisted radical nephrectomy (RARN) in comparison with open radical nephrectomy (ORN) and laparoscopic radical nephrectomy (LRN) based on real-world experience in Japan. We conducted a retrospective appraisal of 165 radical nephrectomy patients managed at a single center over 2015–2025: 36 RARN, 33 ORN, 96 LRN. Patient backgrounds, perioperative outcomes, and disease-free survival (DFS) rates were compared. Propensity score matching (PSM) was performed based on tumor size, ≥pT2 status, and presence of venous tumor thrombi. Compared with ORN, RARN was associated with significantly reduced operative times (median: 180 vs. 235 min, p = 0.018), blood loss (58 vs. 1,187 g, p < 0.001), and hospital stays (6.5 vs. 10 days, p < 0.001). In contrast, LRN demonstrated superior perioperative outcomes compared with RARN in terms of operative times, blood loss, and length of hospital stay. Even after PSM, LRN maintained shorter hospital stays than RARN. Notably, although patients undergoing RARN exhibited a higher prevalence of complex renal tumors, including ≥ pT2 disease and venous tumor thrombi, they still showed favorable outcomes compared with ORN, highlighting its feasibility in high-risk surgical cases. Two-year DFS rates did not differ significantly between groups after adjustment. RARN provides reliable safety and clinical effectiveness in treating advanced or technically challenging renal tumors. However, given its resource intensity and lengthier procedures, LRN is still a suitable approach in low-risk settings. The surgical approach should be selected based on tumor complexity and resource considerations.