Outcomes After Robotic Versus Laparoscopic Partial Nephrectomy: An Updated Meta-Analysis Of 4919 Patients

To evaluate current literature comparing outcomes of robotic partial nephrectomy (RPN) versus laparoscopic partial nephrectomy (LPN).

We performed a literature search according to Cochrane guidelines up to December 2015 including studies comparing RPN and LPN. We compared baseline patient and tumour characteristics. We performed a meta-analysis to evaluate safety, effectiveness and functional outcomes of RPN vs. LPON, using weighted mean difference (WMD) and inverse variance pooled risk ratios (RR) respectively.

A total of 4919 patients were included from 25 studies (2681 RPN, 2238 LPN). No significant differences exist between the 2 groups in terms of age, sex, laterality, and final malignant pathology. RPN patients had larger tumours (WMD= +0.17cm, p=0.001), higher mean RENAL nephrometry scores (WMD= +0.59, , p=0.002) and was associated with decreased likelihood of conversion to laparoscopic/open surgery compared to LPN (RR: 0.36, p<0.001), any (Clavien≥1) (RR: 0.84, p=0.007) and major (Clavien≥3) (RR: 0.71, p=0.023) complications, positive margins (RR: 0.53, p<0.001) and shorter WIT by 4.3 mins (p<0.001). Both approaches had similar operative time (WMD: -12.2 minutes, p=0.34), estimated blood loss (WMD: -24.6 mls, p=0.15) and postoperative change in eGFR.

This updated meta-analysis of retrospective cohort studies found that RPN confers a superior morbidity profile compared to LPN in most of the examined perioperative outcomes. Despite being the strongest available evidence (Level 2b) for outcomes of RPN vs. LPN thus far, there has been no completed or ongoing randomized trials to lend Level 1 support for either approach.

The Journal of urology. 2016 Jun 09 [Epub ahead of print]

Jeffrey J Leow, Nathaniel H Heah, Steven L Chang, Yew Lam Chong, Keng Siang Png

Department of Urology, Tan Tock Seng Hospital, Singapore; Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States. Electronic address: ., Department of Urology, Tan Tock Seng Hospital, Singapore., Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States., Department of Urology, Tan Tock Seng Hospital, Singapore., Department of Urology, Tan Tock Seng Hospital, Singapore.

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