Robot-assisted versus laparoscopic partial nephrectomy for localized renal tumors: a meta-analysis.

Abstract

BACKGROUND: Robot-assisted partial nephrectomy (RAPN) is being performed more frequently for the minimally invasive management of localized renal tumors. However, it's unclear whether RAPN is more efficacious than the standard laparoscopic partial nephrectomy (LPN). The objective of this meta-analysis is to compare RAPN and LPN in terms of perioperative and oncologic outcomes for the treatment of localized renal tumors. METHODS: A systematic search of electronic databases including MEDLINE, EMBASE and OVID was conducted. Comparative studies comparing RAPN and LPN for the treatment of localized renal tumors were regarded eligible. The mean difference (MD), odds ratio (OR) and their corresponding 95% confidence intervals (CI) were calculated for each outcome. The methodologic quality of the included studies was evaluated using the strict criteria of the Newcastle-Ottawa scale. RESULTS: 14 comparative studies (n = 1539 participants) were included in the present meta-analysis. Operative time was similar for RAPN and LPN (MD = 6.33, 95% CI [-23.93, 36.59]), however, warm ischemia time favored RAPN (MD = -3.29, 95% CI [-6.47, -0.10]). There was no significant difference in estimated blood loss (EBL) (MD = -42.24, 95% CI [-87.10, 2.61]) and length of stay (LOS) (MD = -0.29, 95% CI [-0.89, 0.32]). The incidence of intraoperative complications was similar for RAPN and LPN (OR = 0.68, 95% CI [0.29, 1.58]), as well as incidence of postoperative minor complications (OR = 1.10, 95% CI [0.80, 1.51]) and postoperative major complications distributions by Clavien classification (OR = 0.99, 95% CI [0.61, 1.61]). In addition, no significant difference was found in terms of positive surgical margin rate (OR = 1.12, 95% CI [0.56, 2.25]). CONCLUSIONS: RAPN had similar operative time, LOS, EBL, and perioperative complications compared with LPN, as well as positive margin rates. RAPN appears to offer the advantage of decreased WIT compared with LPN. Studies with long-term follow up are needed to compare RAPN and LPN in terms of long-term complications and oncologic outcomes.