The impact of social determinants of health on access to partial nephrectomy, minimally invasive surgery, and robotic-assisted approaches for renal cell carcinoma

Abstract Purpose Social determinants of health (SDOH), including race/ethnicity, socioeconomic status (SES), insurance coverage, and geographic location, are established drivers of disparities in surgical access and outcomes. Robotic-assisted partial nephrectomy (RAPN) has become the preferred minimally invasive approach for localized renal cell carcinoma (RCC), yet the extent to which SDOH influence access to partial nephrectomy, minimally invasive surgery, and RAPN specifically, as well as postoperative outcomes has not been comprehensively characterized. Methods A systematic review was conducted following PRISMA guidelines. PubMed/MEDLINE, Google Scholar, ScienceDirect, Embase, Web of Science, and Scopus were searched in October 2025 for studies evaluating associations between SDOH and surgical management or perioperative outcomes in patients with RCC. Fourteen studies met inclusion criteria. Methodological quality was assessed using the Newcastle-Ottawa Scale. Results Fourteen retrospective observational studies comprising 918,452 patients were included. Lower socioeconomic status, non-White race/ethnicity, public or absent insurance, and treatment at low-volume or non-academic institutions were each independently associated with reduced receipt of guideline-concordant nephron-sparing surgery. Insurance status and race/ethnicity were the most consistently reported determinants. Socioeconomic disadvantage was also associated with increased postoperative complications, longer length of stay, and higher readmission rates. Conclusions SDOH significantly influence both access to nephron-sparing and robotic-assisted surgery and perioperative outcomes in patients with RCC, independent of clinical factors. Because the included studies did not directly evaluate interventions, SDOH screening at referral, patient navigation, expansion of robotic capacity in safety-net hospitals, and reimbursement reform represent potential options for improving equitable delivery of minimally invasive nephron-sparing surgery.