机器人辅助部分肾切除可以通过经腹腔或经腹膜后途径进行。本研究旨在比较利用大型多中心前瞻性维护数据库和倾向性评分匹配分析的研究，比较腹膜后途径（RRPN）和经腹腔途径（TRPN）机器人辅助部分肾切除的三重达标率。该研究由法国肾癌研究网络在UroCCR项目（NCT03293563）下启动。纳入了在15个参与中心进行过TRPN或RRPN的经验丰富的外科医生所进行的手术的患者。收集了有关人口统计学和临床参数、肿瘤特征、肾功能和手术参数的数据。主要结局是三重达标率，定义为温缺血时间小于25分钟、手术边缘无病变和无重大并发症。次要结局包括手术时间、住院时间、失血量、术后并发症、术后肾功能和每个三重达标项目单独进行分析。根据肿瘤位置进行亚组分析。共有2879例患者（2581例TRPN vs. 298例RRPN）纳入研究。匹配之前，TRPN组患者的三重达标率为73.0%，RRPN组为77.5%（P=0.094）。TRPN组的157例患者和RRPN组的157例患者之间匹配后，TRPN组的三重达标率为82.8%，RRPN组为84.0%（P=0.065）。RRPN组的手术时间较短（123 vs. 171分钟；P<0.001），失血量较少（161 vs. 293mL；P<0.001）。对于后部肿瘤，RRPN组的三重达标率高于TRPN组（71% vs. 81%；P=0.017）。RRPN是经腹膜后途径的可行替代方法，特别适用于后部肾肿瘤，是部分肾切除的安全有效选项。

Robot-assisted partial nephrectomy can be performed through either a transperitoneal or retroperitoneal approach. This study aimed to compare the rate of trifecta achievement between retroperitoneal (RRPN) and transperitoneal (TRPN) robot-assisted partial nephrectomy using a large multicenter prospectively-maintained database and propensity-score matching analysis.This study was launched by the French Kidney Cancer Research Network, under the UroCCR Project (NCT03293563). Patients who underwent TRPN or RRPN by experienced surgeons in 15 participating centers were included. Data on demographic and clinical parameters, tumor characteristics, renal function, and surgical parameters were collected. The primary outcome was the rate of trifecta achievement, which was defined as a warm ischemia time of less than 25 minutes, negative surgical margins, and no major complications. Secondary outcomes included operative time, hospital length-of-stay, blood loss, postoperative complications, postoperative renal function, and each trifecta item taken alone. Subgroup analysis was done according to tumor location.A total of 2879 patients (2581 TRPN vs. 298 RRPN) were included in the study. Before matching, trifecta was achieved in 73.0% of the patients in the TRPN group compared to 77.5% in the RRPN group (P=0.094). After matching 157 patients who underwent TRPN to 157 patients who underwent RRPN, the trifecta rate was 82.8% in the TRPN group vs. 84.0% in the RRPN group (P=0.065). The RRPN group showed shorter operative time (123 vs. 171 min; P<0.001) and less blood loss (161 vs. 293 mL; P<0.001). RRPN showed a higher trifecta achievement for posterior tumors than TRPN (71% vs. 81%; P=0.017).RRPN is a viable alternative to the transperitoneal approach, particularly for posterior renal tumors, and is a safe and effective option for partial nephrectomy.