Comparative outcomes of robot-assisted, laparoscopic, and open radical nephrectomy: A Taiwan population-based study

Radical nephrectomy continues to be the established treatment for patients with large or locally advanced renal tumors. Although the use of robot-assisted techniques has grown substantially in recent years, their definitive advantages compared to traditional laparoscopic or open surgeries remain unclear. This retrospective, population-based analysis utilized data from the Taiwan Cancer Registry Database (TCRD) for patients who underwent open, laparoscopic, or robot-assisted radical nephrectomy between 2018 and 2020. Postoperative outcomes were assessed using the National Health Insurance Research Database (NHIRD), with follow-up information available through 2021. This study demonstrates that minimally invasive techniques (robotic-assisted RN (RARN) and laparoscopic RN (LRN)) were associated with lower blood transfusion rates, shorter length of hospital stays (LOS), and reduced ICU (intensive care unit) admissions compared to open radical nephrectomy (ORN), both before and after Inverse Probability of Treatment Weighting (IPTW) adjustment. Additionally, RARN showed a lower overall complication rate compared to ORN, though reoperation and readmission rates remained similar among all groups. Despite these perioperative advantages, no significant differences in overall survival were observed among the three surgical techniques. The results of the study highlight the potential benefits of robotic and laparoscopic approaches in improving short-term surgical outcomes without compromising long-term survival. Interpretation is constrained by database limitations and residual selection bias.