Risk Factors for Recurrence Following Robot-Assisted Laparoscopic Partial Nephrectomy (RAPN): A Single-Center Retrospective Study

Background The recurrence rate after robot-assisted laparoscopic partial nephrectomy (RAPN) for renal cell carcinoma varies, and few established risk factors have been identified. We investigated the postoperative recurrence rate and its risk factors following RAPN. Methods Among 221 patients who underwent RAPN at our institution from 2016 to 2024, we collected patient background and surgical information for 205 patients diagnosed with renal cell carcinoma (excluding benign diseases). We retrospectively examined postoperative recurrence rates and risk factors for recurrence. Results Postoperative recurrence was observed in 11 cases: 3 local recurrences and 8 non-local recurrences. The postoperative recurrence rate was 5.3%. The median time to postoperative recurrence was 15 months. Univariate analysis identified sex, lateral renal fat thickness, dorsal renal fat thickness, tumor size, operative time, warm ischemia time, pathological tumor (pT) stage ≥ 3a, and Fuhrman grade ≥ 3 as factors associated with postoperative recurrence. Receiver operating characteristic curve analysis identified the following cutoff values: tumor size: 34 mm, lateral renal fat thickness: 20.73 mm, dorsal renal fat thickness: 11.85 mm, and warm ischemia time: 24 minutes. Multivariate analysis identified pT stage ≥ 3a (odds ratio: 6.61, 95% confidence interval: 1.05–41.6; p = 0.04) and Fuhrman grade ≥ 3 (odds ratio: 7.81, 95% confidence interval: 1.69–36.1; p < 0.01) as independent predictors of postoperative recurrence. Positive resection margins were observed in seven cases (3.4%); however, postoperative recurrence occurred in only one of these seven cases, suggesting no association with postoperative recurrence. Conclusions Positive resection margins were not associated with the risk of postoperative recurrence after RAPN for renal cell carcinoma. pT stage ≥ 3a and Fuhrman grade ≥ 3 were significantly and independently associated with postoperative recurrence.