Objective: To compare peri-operative factors and renal function following open partial nephrectomy (OPN) and robotic partial nephrectomy (RPN) for intermediate and high complexity tumors when controlling for tumor and patient complexity.

Methods: A retrospective review of 222 patients undergoing partial nephrectomy was performed. Patients with intermediate (nephrometry score NS 7–9) or high (NS 10–12) complexity tumors were matched 2:1 for RPN:OPN using NS, Charlson Comorbidity Index (CCI), and BMI. Patient demographics, peri-operative values, renal function, and complication rates were analyzed and compared.

Results: Seventy-four OPN patients were matched to 148 RPN patients with no difference in patient demographics. Estimated blood loss in OPN patients was significantly higher (368.5 vs 210.5 mL, p < 0.001) as was transfusion rate (17% vs 1.6%, p < 0.001). Warm ischemia time was longer in OPN (25.5 vs 19.7 min, p = 0.001) while operative time was reduced (200.5 vs 226.5 min, p = 0.010). RPN patients had significantly shorter hospitalizations (5.3 vs 3.0 days, p < 0.001). GFR decrease after one month was not statistically significant (12.9 vs 6.6 ml/min, p = 0.130). Clavien III–V complications incidence was higher for OPN compared to RPN although not significantly (20.3% vs 10.8%, p = 0.055).

Conclusion: When matching for tumor and patient complexity, RPN patients had fewer high grade post-operative complications, decreased blood loss, and shorter hospitalizations. RPN is a safe option for patients with intermediate and high complexity tumors.

目的：比较开放性部分肾切除术（OPN）和机器人部分性肾切除术（RPN）对中度和高度复杂性肿瘤在控制肿瘤和患者复杂性时的围手术期因素和肾功能。

方法：回顾性分析222例接受部分肾切除术的患者。使用NS，Charlson合并症指数（CCI）和BMI，对中度（肾病学分数NS 7-9）或高（NS 10-12）复杂性肿瘤的患者进行RPN：OPN 2：1匹配。分析并比较了患者的人口统计学，围手术期值，肾功能和并发症发生率。

结果： 74例OPN患者与148例RPN患者匹配，患者人口统计学无差异。OPN患者的估计失血量显着更高（368.5 vs 210.5 mL，p  <0.001）和输血率（17％vs 1.6％，p  <0.001）。OPN的热缺血时间更长（25.5 vs 19.7 min，p  = 0.001），而手术时间减少了（200.5 vs 226.5 min，p  = 0.010）。RPN患者的住院时间明显缩短（5.3天与3.0天，p  <0.001）。一个月后GFR下降无统计学意义（12.9 vs 6.6 ml / min，p = 0.130）。与RPN相比，OPN的Clavien III–V并发症发生率更高，尽管不显着（20.3％对10.8％，p  = 0.055）。

结论：根据肿瘤和患者的复杂性，RPN患者术后并发症少，失血量少，住院时间短。对于中度和高度复杂性肿瘤的患者，RPN是一种安全的选择。