PN refers to the standard therapy for localized renal tumors, while outcomes vary with surgeon expertise, tumor features, and APF presence (Khene et al. 2018). The PADUA score is a straightforward anatomical assessment tool evaluating not only tumor size but also the association between the tumor and renal sinus vessels, the proportion of the tumor, its relationship to the renal pelvis and collecting system, and its positioning when compared with the lateral and dorsal aspects of the kidney. This system is beneficial for assessing the risk of complications both during surgery and the perioperative period in patients undergoing partial nephrectomy (Schiavina et al. 2017). However, this renal tumor grading system primarily concentrates on the anatomical features of the tumor and ignores its interactions with the surrounding environment. The presence of APF significantly complicates the mobilization and exposure of the internal tumor, which can increase the risk of local injury. By contrast, the MAP scoring system quantitatively evaluates a patient’s APF and provides an effective prediction of surgical difficulty (Davidiuk et al. 2014). Managing complex renal tumors with LPN is demanding, usually causing extended OT and increased complications. Considering the advantages of robotic surgery, RAPN is currently a well-accepted alternative to OPN and LPN for the therapy of renal tumors (Deng et al. 2019). The existing studies on RAPN and LPN primarily assess renal tumor complexity using the R.E.N.A.L. score (Deng et al. 2019; Zhang et al. 2023; Wang et al. 2023). The PADUA score and the R.E.N.A.L. score have demonstrated reliability, serving as effective quantitative tools for characterizing renal tumors (Okhunov et al. 2011; Alvim et al. 2018). Different from the R.E.N.A.L. score, requiring precise measurement of the tumor’s distance from the renal sinus and collecting system, the PADUA score adopts a more identifiable renal sinus line for assessing the tumor’s coronal position. It simplifies scoring by evaluating the relationships between anatomical structures rather than depending on exact measurements, making it more practical for clinical use. This study thoroughly compared RAPN and LPN using the PADUA score, underscoring the considerable value of the PADUA score and the MAP score in predicting postoperative complications. This study not only confirms the predictive value of the PADUA score for surgical complications but also systematically evaluates the MAP score in complex renal tumor surgeries, highlighting its utility in assessing intraoperative difficulty quantitatively. Distinct from prior research, this study uses the PADUA score to compare RAPN and LPN outcomes, with patients stratified into low-, moderate-, and high-complexity groups. Such subgroup analysis provides clearer guidance for surgical approach selection and preoperative risk assessment in renal tumor cases. By using both the PADUA and MAP scores to predict postoperative complications, these findings offer more precise insights to support surgical decision-making across varied complexity levels.

Benway et al.‘s multicenter retrospective study indicated no obvious differences in OT and PSM rates between RAPN and LPN. Nevertheless, RAPN was correlated with lower EBL, shorter LOS, and significantly lowered WIT than LPN (Benway et al. 2009). The meta-analysis conducted by Leow et al. revealed that RAPN had clear advantages over LPN regarding intraoperative complications (e.g., conversion to open surgery), postoperative complications, PSM, and WIT. However, no notable differences were found in OT, EBL, or postoperative eGFR (Leow et al. 2016). Choi et al.‘s meta-analysis observed no obvious differences between RAPN and LPN regarding OT, EBL, PSM, and postoperative complications. However, RAPN had notably lower conversion rates to open or radical surgery, reduced WIT, less eGFR decline, as well as shorter LOS (Choi et al. 2015).

Our study found that in the low-to-moderate complexity groups, OT revealed no significant difference between RAPN and LPN. This lack of difference in OT might be caused by the more complex preoperative preparation required for RAPN, which can prolong overall surgical duration. Nevertheless, the robotic system enhances surgical precision, flexibility, and visibility, contributing to reduced intraoperative injuries and improved efficiency. Thus, in the high-complexity group, OT showed a significant difference between RAPN and LPN, contrasting with the findings of Benway et al., Leow et al., and Choi et al. Additionally, RAPN reduced WIT more than LPN across the three complexity groups, aligning with the results of Benway et al., Leow et al., and Choi et al. When WIT exceeds 30 min, eGFR significantly declines, and each additional minute beyond this threshold adversely influences renal function protection (Thompson et al. 2010). RAPN had a lesser impact on eGFR than LPN among the three complexity groups, and less EBL in the high-complexity group aligning with Choi et al.‘s findings. Unlike studies by Benway et al. and Choi et al., our research indicated that RAPN reduced LOS in moderate- and high-complexity groups, but no significant difference in LOS was observed in low-complexity groups. Furthermore, no significant differences in drainage tube retention time were observed among the three groups.

The current work revealed a significant association between the PADUA score and OT, WIT, EBL, and postoperative length of stay for RAPN and LPN groups. Similarly, the MAP score exhibited a strong correlation with OT, EBL, and postoperative length of stay. These findings suggest that both the PADUA score and the MAP score effectively reflect the PN complexity of partial nephrectomy (Schiavina et al. 2017; Ficarra et al. 2009; Thompson et al. 2010). An obvious association was not found between the MAP score and WIT for either RAPN or LPN (r = 0.124, r = 0.002). The lack of correlation is probably due to the fact that perirenal fat is adequately separated prior to renal artery occlusion in both procedures, ensuring sufficient tumor exposure. Therefore, the degree of perirenal fat adhesion did not influence the WIT. However, APF may cause localized damage. Literature reports suggest that the incidence of AFP ranges from 10.6 to 40.8% 7,19–21. Further research exhibits a strong correlation between higher MAP scores and adverse perioperative outcomes which include prolonged hospital stay, increased EBL, and extended OT (Kocher et al. 2016; Dariane et al. 2017). The present study found RAPN had clear advantages over LPN regarding intraoperative complications aligning with Leow et al. findings (Leow et al. 2016). In the RAPN group, there were two vascular injuries and one case needed conversion to radical resection. In the LPN group, there was one case of vascular injury, two cases required conversion to radical resection, and one required open surgery. Factors causing conversion to radical nephrectomy included tumor size, a high complexity score, and PSM, with bleeding or impaired renal function as secondary reasons. The incidence of reporting has declined during the years, decreasing from 13% in 2000–2003 to 4% in 2012–2015 (Kara et al. 2017; Tsivian et al. 2022; Jin et al. 2020). Studies indicate that robot-assisted systems effectively minimize renal pedicle injuries, facilitate the removal of hard-to-access tumors, and maintain lower rates of radical and open conversions, which can therefore lower the risk of intraoperative complications (Choi et al. 2015). Our study also indicated that RAPN has higher PSM rates than LPN, likely due to the robotic system’s precision in preserving kidney tissue (Luciani et al. 2017). This serves as a cautionary note.

The postoperative complication rates were 9.2% for RAPN and 11.22% for LPN, consistent with previous studies (Benway et al. 2009; Luciani et al. 2017; Bier et al. 2017). The majority of postoperative complications fell within the Clavien-Dindo grade ≤ 2 classification. Both RAPN and LPN showed an increasing trend in overall postoperative complication rates, with higher PADUA and MAP scores. Retrospective and prospective studies have revealed comparable safety profiles for LPN and RAPN (Benway et al. 2009; Choi et al. 2015; Deng et al. 2019; Masson-Lecomte et al. 2013). Ficarra et al. demonstrated that anatomical characteristics evaluated with the PADUA score (OR,1.427;95%CI,1.149–1.773;P < 0.001) independently predicted overall complication rates (Ficarra et al. 2012). Davidiuk et al. and Shumate et al. indicated that APF exerted no significant influence on perioperative complications or outcomes (Shumate et al. 2019; Davidiuk et al. 2015). By contrast, Bier et al. demonstrated that MAP score, a precise tool for predicting APF, significantly correlated with the occurrence of postoperative complications (Bier et al. 2017).

In the RAPN and LPN cohorts, the MAP score did not outperform random prediction for forecasting urinary fistula. This complication is typically resulted from tumor invasion into the collecting system, which is related to the anatomy of the tumor rather than the peripheral renal fat. However, both the PADUA score and the MAP score showed predictive values for overall postoperative complications, with all AUC values exceeding 0.5.

Furthermore, the results of this study are consistent with findings from other multicenter studies. For example, in a multicenter analysis focusing on complex renal tumors, RAPN demonstrated higher operational safety and functional preservation advantages in complex cases without increasing the risk of complications (Cerrato et al. 2023a, b). Another study further emphasized the benefits of PN in renal function preservation, particularly for patients with high-complexity renal tumors, which aligns with the superiority of RAPN in postoperative eGFR preservation observed in our study (Cerrato et al. 2023a, b). These findings suggest the potential advantages of RAPN in managing complex renal tumors, highlighting its superiority not only in surgical safety and complication risk control but also in renal function preservation, thereby supporting clinical decision-making for personalized treatment.

Overall, this study provides a deeper comparative perspective on RAPN and LPN through subgroup analysis and multidimensional scoring system evaluation. Our findings not only emphasize the potential clinical benefits of choosing RAPN for tumors of varying complexities but also demonstrate how the PADUA and MAP scoring systems can be utilized to optimize individualized treatment decisions. Compared to studies using single scoring systems, our approach offers more comprehensive guidance for preoperative planning in partial nephrectomy. Limitations of this study include its retrospective design and small sample size, highlighting the need for larger, prospective multicenter studies to validate these findings. Additionally, other anatomical scoring systems, such as the R.E.N.A.L. and C-index scores, were not evaluated. The short post-operative follow-up may have missed delayed complications and long-term renal function recovery.