-
Urologia Internationalis 2022Robot-assisted partial nephrectomy (RAPN) has been increasingly used for renal cell carcinoma in recent years. But the advantages of RARN over open partial nephrectomy... (Meta-Analysis)
Meta-Analysis
INTRODUCTION
Robot-assisted partial nephrectomy (RAPN) has been increasingly used for renal cell carcinoma in recent years. But the advantages of RARN over open partial nephrectomy (OPN) are still controversial.
METHODS
We searched the articles between 1997 and 2021 in PubMed, Web of Science, Cochrane Library, and EMbase databases. The parameters were perioperative outcomes including operating time (OT), warm ischemic time (WIT), estimated blood loss (EBL), positive surgical margin (PSM), preoperative and postoperative estimated glomerular filtration rate (eGFR), length of stay (LOS), and intraoperative and postoperative complications. Stata 13.0 software was used for the meta-analysis.
RESULTS
Seven studies with 2,646 patients (1,285 in RAPN vs. 1,361 in OPN) were included in the analysis. There were no significant differences in OT (WMD [95% confidence interval (CI)]: 0.14 [-0.33, 0.61], p = 0.570); WIT (WMD [95% CI]:0.28 [-0.13, 0.69], p = 0.187); PSM (odds ratio [OR] [95% CI]: 1.04 [0.37, 2.94], p = 0.944); preoperative eGFR (OR [95% CI]: 0.11 [-0.01, 0.23], p = 0.071); postoperative eGFR (OR [95% CI]: -0.11 [0.27, 0.04], p = 0.159); and intraoperative complications (OR [95% CI]: 0.13 [0.02, 1.04], p = 0.055) between 2 groups. But there were still less EBL (WMD [95% CI]: -0.67 [-1.07, -0.28], p = 0.001), shorter LOS (WMD [95% CI]: -1.09 [-1.86, -0.32], p = 0.005) and fewer postoperative complications (OR [95% CI]: 0.51 [0.38, 0.68], p = 0.000).
CONCLUSIONS
Compared with OPN, RAPN appears to achieve partly similar short-term functional outcomes. Meanwhile, some results are inconsistent with previous studies which seem to show that tumor type is also an important factor in comparison between RAPN and OPN, but the analysis is not carried out due to lack of complete data. Therefore, more high-quality random controlled trials are acquired.
Topics: Carcinoma, Renal Cell; Humans; Kidney Neoplasms; Margins of Excision; Nephrectomy; Postoperative Complications; Retrospective Studies; Robotic Surgical Procedures; Robotics; Treatment Outcome
PubMed: 35193139
DOI: 10.1159/000521881 -
Investigative and Clinical Urology Sep 2020This study aimed to determine the effectiveness and safety of partial nephrectomy (PN) without ischemia compared with PN with warm ischemia for reducing the... (Comparative Study)
Comparative Study Meta-Analysis
PURPOSE
This study aimed to determine the effectiveness and safety of partial nephrectomy (PN) without ischemia compared with PN with warm ischemia for reducing the deterioration in renal function in patients with cT1 renal tumors.
MATERIALS AND METHODS
We conducted a systematic review that included patients over 18 years of age who underwent PN with or without warm ischemia for cT1 renal tumors. The primary outcome was impaired renal function. A search strategy was performed in MEDLINE, EMBASE, LILACS, CENTRAL, the article reference lists, and the unpublished literature to reach saturation of the information. We assessed the risk of bias with the methodological index for nonrandomized studies (MINORS) tool, and we performed a meta-analysis according to the type of variable.
RESULTS
We found a total of 5,682 articles, of which 14 met the inclusion criteria. Seven studies evaluated renal function, identifying a difference in means (MD) of 3.50 (95% confidence interval [CI], 1.16 to 5.83), favoring no ischemia. We did not find any significant differences regarding intraoperative bleeding or operative time (MD, 55 mL; 95% CI, -33.16 to 144.08; and MD, 1.87; 95% CI, -20.47 to 24.21; respectively).
CONCLUSIONS
In this study, PN without ischemia showed a decrease in deterioration of the estimated glomerular filtration rate compared with warm ischemia.
Topics: Humans; Kidney Neoplasms; Neoplasm Staging; Nephrectomy; Treatment Outcome; Warm Ischemia
PubMed: 32869563
DOI: 10.4111/icu.20190313 -
Frontiers in Oncology 2023In recent years, enhanced recovery after surgery (ERAS) has been widely used in the field of urology, especially in radical cystectomy and radical prostatectomy, and has...
OBJECTIVES
In recent years, enhanced recovery after surgery (ERAS) has been widely used in the field of urology, especially in radical cystectomy and radical prostatectomy, and has demonstrated its advantages. Although studies on the application of ERAS in partial nephrectomy for renal tumors are increasing, the conclusions are mixed, especially in terms of postoperative complications, etc, and its safety and efficacy are questionable. We conducted a systematic review and meta-analysis to assess the safety and efficacy of ERAS in the application of partial nephrectomy for renal tumors.
METHODS
Pubmed, Embase, Cohrance library, Web of science and Chinese databases (CNKI, VIP, Wangfang and CBM) were systematically searched for all published literature related to the application of enhanced recovery after surgery in partial nephrectomy for renal tumors from the date of establishment to July 15, 2022, and the literature was screened by inclusion/exclusion criteria. The quality of the literature was evaluated for each of the included literature. This Meta-analysis was registered on PROSPERO (CRD42022351038) and data were processed using Review Manager 5.4 and Stata 16.0SE. The results were presented and analyzed by weighted mean difference (WMD), Standard Mean Difference (SMD) and risk ratio (RR) at their 95% confidence interval (CI). Finally, the limitations of this study are analyzed in order to provide a more objective view of the results of this study.
RESULTS
This meta-analysis included 35 literature, including 19 retrospective cohort studies and 16 randomized controlled studies with a total of 3171 patients. The ERAS group was found to exhibit advantages in the following outcome indicators: postoperative hospital stay (WMD=-2.88, 95% CI: -3.71 to -2.05, p<0.001), total hospital stay (WMD=-3.35, 95% CI: -3.73 to -2.97, p<0.001), time to first postoperative bed activity (SMD=-3.80, 95% CI: -4.61 to -2.98, p < 0.001), time to first postoperative anal exhaust (SMD=-1.55, 95% CI: -1.92 to -1.18, p < 0.001), time to first postoperative bowel movement (SMD=-1.52, 95% CI: -2.08 to -0.96, p < 0.001), time to first postoperative food intake (SMD=-3.65, 95% CI: -4.59 to -2.71, p<0.001), time to catheter removal (SMD=-3.69, 95% CI: -4.61 to -2.77, p<0.001), time to drainage tube removal (SMD=-2.77, 95% CI: -3.41 to -2.13, p<0.001), total postoperative complication incidence (RR=0.41, 95% CI: 0.35 to 0.49, p<0.001), postoperative hemorrhage incidence (RR=0.41, 95% CI: 0.26 to 0.66, p<0.001), postoperative urinary leakage incidence (RR=0.27, 95% CI: 0.11 to 0.65, p=0.004), deep vein thrombosis incidence (RR=0.14, 95% CI: 0.06 to 0.36, p<0.001), and hospitalization costs (WMD=-0.82, 95% CI: -1.20 to -0.43, p<0.001).
CONCLUSION
ERAS is safe and effective in partial nephrectomy of renal tumors. In addition, ERAS can improve the turnover rate of hospital beds, reduce medical costs and improve the utilization rate of medical resources.
SYSTEMATIC REVIEW REGISTRATION
https://www.crd.york.ac.uk/PROSPERO, identifier CRD42022351038.
PubMed: 36845687
DOI: 10.3389/fonc.2023.1049294 -
Frontiers in Oncology 2019Tumor enucleation (TE) and partial nephrectomy (PN) have both become main treatment strategies for T1 renal cell carcinoma (RCC), despite the discrepancy between their...
Tumor enucleation (TE) and partial nephrectomy (PN) have both become main treatment strategies for T1 renal cell carcinoma (RCC), despite the discrepancy between their safety margin. We performed a meta-analysis on all the relevant trials in order to compare the clinical efficacy and safety of TE with those of PN for RCC treatment. In this meta-analysis, randomized controlled trials or retrospective studies were included if they compared TE and PN therapy in patients with localized renal cancer. The main outcomes extracted were perioperative data and post-operative outcomes. Subgroups for analyses were undertaken according to tumor size and duration of follow up. Data were pooled using the generic variance method with a fixed or random effects model and expressed as mean differences or odds ratios with 95% CI. A total of 13 studies containing 1,792 patients undergoing TE and 3,068 undergoing PN were identified. Our study showed that the patients received TE had significantly shorter operative time (MD = -28.46, 95% CI = -42.09, -14.83, < 0.0001), less hospital day (MD = -0.68, 95% CI = -1.04, -0.31, = 0.0003), less estimate blood loss (MD = -59.90, 95% CI = -93.23, -26.58, = 0.0004) and smaller change in estimated glomerular filtration rate (fixed effect: MD = 4.66, 95% CI = 1.67, 7.66, = 0.002), fewer complications (fixed effect: OR = 0.65, 95% CI = 0.50, 0.85, = 0.001) compared with those received PN. However, there were no significant differences in terms of warm ischemic time, positive margin rates, recurrence rates and survival rates between the two groups. All the subgroup analyses presented consistent results with the overall analyses. Our findings suggested that TE is not only less-traumatizing and beneficial for recovery, but also better for renal function protection. Moreover, it did not show the evidence of an increase relapse rate or mortality rate when compared with PN.
PubMed: 31214511
DOI: 10.3389/fonc.2019.00473 -
In Vivo (Athens, Greece) 2022Trifecta represents a composite outcome reflecting the quality level of treatment in nephron sparing surgery. However, there is substantial heterogeneity concerning the... (Review)
Review
BACKGROUND/AIM
Trifecta represents a composite outcome reflecting the quality level of treatment in nephron sparing surgery. However, there is substantial heterogeneity concerning the criteria required for its fulfilment. The present study aimed to highlight the potential of a unified view for the different definitions of trifecta when comparing robotic and open approaches in partial nephrectomy.
MATERIALS AND METHODS
A systematic literature search was carried out for all relevant comparative studies published until April 2022. Trifecta definitions were clustered according to two criteria for postoperative renal function reduction. The first set as an upper limit the 10% decrease in the estimated glomerular filtration rate, while the second set as an upper limit 25 min of ischemia. To mathematically investigate the point of intersection between the above two groups, a suitable model of volume conservation equations was formulated.
RESULTS
A total of 11 studies were investigated for their methodological features and grouped accordingly. The ischemic zone volume surrounding the tumor resection site emerged as the central parameter connecting the two main definitions. Specifically, for patients with solitary renal masses, a given change in the value of one parameter resulted in a fixed change in the value of the other.
CONCLUSION
The two main definitions of the "trifecta outcome" extracted from the international literature represent the two sides of the same coin. Thus, trifecta achievement rates could be utilized by future studies as aggregate data to yield a quantitative estimate of the comparative effect between robotic and open approaches in partial nephrectomy procedures.
Topics: Humans; Models, Theoretical; Nephrectomy; Robotic Surgical Procedures; Treatment Outcome
PubMed: 36309375
DOI: 10.21873/invivo.12992 -
Frontiers in Surgery 2022Partial nephrectomy (PN) is one of the most preferred nephron-sparing treatments for clinical T1 (cT1) renal cancer, while radiofrequency ablation (RFA) is usually used...
BACKGROUND
Partial nephrectomy (PN) is one of the most preferred nephron-sparing treatments for clinical T1 (cT1) renal cancer, while radiofrequency ablation (RFA) is usually used for patients who are poor surgical candidates. The long-term oncologic outcome of RFA vs. PN for cT1 renal cancer remains undetermined. This meta-analysis aims to compare the treatment efficacy and safety of RFA and PN for patients with cT1 renal cancer with long-term follow-up of at least 5 years.
METHOD
This meta-analysis was performed following the PRISMA reporting guidelines. Literature studies that had data on the comparison of the efficacy or safety of RFA vs. PN in treating cT1 renal cancer were searched in databases including PubMed, Embase, Web of Science, and the Cochrane Library from 1 January2000 to 1 May 2022. Only long-term studies with a median or mean follow-up of at least 5 years were included. The following measures of effect were pooled: odds ratio (OR) for recurrence and major complications; hazard ratio (HR) for progression-free survival (PFS), cancer-specific survival (CSS), and overall survival (OS). Additional analyses, including sensitivity analysis, subgroup analysis, and publication bias analysis, were also performed.
RESULTS
A total of seven studies with 1,635 patients were finally included. The treatment efficacy of RFA was not different with PN in terms of cancer recurrence (OR = 1.22, 95% CI, 0.45-3.28), PFS (HR = 1.26, 95% CI, 0.75-2.11), and CSS (HR = 1.27, 95% CI, 0.41-3.95) as well as major complications (OR = 1.31, 95% CI, 0.55-3.14) ( > 0.05 for all). RFA was a potential significant risk factor for OS (HR = 1.76, 95% CI, 1.32-2.34, < 0.001). No significant heterogeneity and publication bias were observed.
CONCLUSION
This is the first meta-analysis that focuses on the long-term oncological outcomes of cT1 renal cancer, and the results suggest that RFA has comparable therapeutic efficacy with PN. RFA is a nephron-sparing technique with favorable oncologic efficacy and safety and a good treatment alternative for cT1 renal cancer.
PubMed: 36684152
DOI: 10.3389/fsurg.2022.1012897 -
Minerva Urology and Nephrology Oct 2022Augmented reality (AR) applied to surgical procedures refers to the superimposition of preoperative or intraoperative images into the operative field. Augmented reality...
INTRODUCTION
Augmented reality (AR) applied to surgical procedures refers to the superimposition of preoperative or intraoperative images into the operative field. Augmented reality has been increasingly used in myriad surgical specialties including urology. The following study reviews advance in the use of AR for improvements in urologic outcomes.
EVIDENCE ACQUISITION
We identified all descriptive, validity, prospective randomized/nonrandomized trials and retrospective comparative/noncomparative studies about the use of AR in urology until March 2021. The Medline, Scopus, and Web of Science databases were used for literature search. We conducted the study selection according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analysis Statement) Guidelines. We limited included studies to only those using AR, excluding all that used virtual reality technology.
EVIDENCE SYNTHESIS
A total of 60 studies were identified and included in the present analysis. Overall, 19 studies were descriptive/validity/phantom studies for specific AR methodologies, 4 studies were case reports, and 37 studies included clinical prospective/retrospective comparative studies.
CONCLUSIONS
Advances in AR have led to increasing registration accuracy as well as increased ability to identify anatomic landmarks and improve outcomes during urologic procedures such as RARP and robot-assisted partial nephrectomy.
Topics: Augmented Reality; Prospective Studies; Retrospective Studies; Urology; Virtual Reality
PubMed: 35383432
DOI: 10.23736/S2724-6051.22.04726-7 -
Urology Journal Mar 2020Radical nephrectomy (RN) and partial nephrectomy (PN) are widely used for early-stage renal cell carcinoma (RCC). However, the results were inconsistent while comparing... (Meta-Analysis)
Meta-Analysis
PURPOSE
Radical nephrectomy (RN) and partial nephrectomy (PN) are widely used for early-stage renal cell carcinoma (RCC). However, the results were inconsistent while comparing the efficiency of RN and PN. This study aimed to assess the perioperative effectiveness of RN and PN for treating RCC.
MATERIAL AND METHODS
PubMed, Embase, and the Cochrane Library electronic database were searched for studies on adults with RCC comparing RN and PN published until September 2019. The perioperative efficacy and safety outcomes were calculated using odds ratio (OR) and standard mean difference (SMD) with 95% confidence intervals (CIs) for dichotomous and continuous data, respectively. Subgroup analysis were conducted based on tumor stage and surgery methods for evaluation of the treatment effect on specific subsets.
RESULTS
A total of 23 studies involving 30,018 patients with RCC were included in this meta-analysis. Notably, RCC treated with PN was associated with low incidences of hospital mortality (OR: 0.58; 95% CI: 0.38-0.89; P = 0.013) and reoperation rate (OR: 0.74; 95% CI: 0.58-0.95; P = 0.016) as compared to RN. However, PN was associated with an increased risk of overall postoperative complications (OR: 1.40; 95% CI: 1.17-1.68, P < 0.001), postoperative hemorrhagic complications (OR: 1.92; 95% CI: 1.28-2.87, P = 0.002), and urinary fistula (OR: 17.65; 95% CI: 5.35-58.30, P < 0.001) as compared to RN.
CONCLUSION
These findings suggested that PN was associated with lower incidences of hospital mortality and reoperation rate, whereas RN was associated with fewer complications.
Topics: Carcinoma, Renal Cell; Humans; Neoplasm Staging; Nephrectomy; Postoperative Complications; Reoperation; Treatment Outcome
PubMed: 32180211
DOI: 10.22037/uj.v0i0.5358 -
International Journal of Surgery... Dec 2020To investigate the overall prevalence of benign pathology after partial nephrectomy (PN) and identify predictive factors for benign pathology after PN. (Meta-Analysis)
Meta-Analysis
OBJECTIVE
To investigate the overall prevalence of benign pathology after partial nephrectomy (PN) and identify predictive factors for benign pathology after PN.
METHODS
A systematic review was performed following the PRISMA guidelines. PubMed/Medline, Embase, and the Cochrane Library were searched up to January 2019PRISMA guidelines. The data for the meta-analysis and network meta-analysis were pooled using a random-effects model.
RESULTS
There were 144 studies included in the final analysis, which was comprised of 79 observational studies (n = 37,300) and 65 comparative studies (n = 18,552). The overall prevalence rate of benign pathology after PN was 0.19 (95% CI: 0.18-0.21). According to the procedure types, the prevalence rate of benign pathology was 0.17 (95% CI: 0.15-0.19), 0.24 (95% CI: 0.22-0.27), and 0.16 (95% CI: 0.15-0.18) in open partial nephrectomy, laparoscopic partial nephrectomy, and robot-assisted laparoscopic partial nephrectomy, respectively. The significant moderating factors were gender, publication year, the origin of the study, and procedure types. The three most common benign pathology types were oncocytomas, angiomyolipomas, and renal cysts (44.50%, 30.20%, and 10.99%, respectively).
CONCLUSIONS
The overall prevalence of benign pathology after PN was not low and it was affected by female gender, studies published before 2010, studies originating from Western areas, and laparoscopic procedure types.
Topics: Angiomyolipoma; Humans; Kidney Neoplasms; Laparoscopy; Nephrectomy; Prevalence; Robotic Surgical Procedures
PubMed: 33220454
DOI: 10.1016/j.ijsu.2020.11.009 -
Frontiers in Oncology 2023The effect of perioperative blood transfusion (PBT) on postoperative survival in RCC patients who underwent partial nephrectomy (PN) or radical nephrectomy (RN) remains...
BACKGROUND
The effect of perioperative blood transfusion (PBT) on postoperative survival in RCC patients who underwent partial nephrectomy (PN) or radical nephrectomy (RN) remains controversial. Two meta-analyses in 2018 and 2019 reported the postoperative mortality of PBT patients with RCC, but they did not investigate the effect on the survival of patients. We performed a systematic review and meta-analysis of relevant literature to demonstrate whether PBT affected postoperative survival in RCC patients who received nephrectomy.
METHODS
Pubmed, Web of Science, Cochrane, and Embase databases were searched. Studies comparing RCC patients with or without PBT following either RN or PN were included in this analysis. Newcastle-Ottawa Scale (NOS) was used to evaluate the quality of the included literature, and hazard ratios (HRs) of overall survival (OS), recurrence-free survival (RFS), and cancer-specific survival (CSS), as well as 95% confidence intervals, were considered as effect sizes. All data were processed using Stata 15.1.
RESULTS
Ten retrospective studies involving 19,240 patients were included in this analysis, with the publication dates ranging from 2014 to 2022. Evidence revealed that PBT was significantly associated with the decline of OS (HR, 2.62; 95%CI: 1,98-3.46), RFS (HR, 2.55; 95%CI: 1.74-3.75), and CSS (HR, 3.15; 95%CI: 2.3-4.31) values. There was high heterogeneity among the study results due to the retrospective nature and the low quality of the included studies. Subgroup analysis findings suggested that the heterogeneity of this study might be caused by different tumor stages in the included articles. Evidence implied that PBT had no significant influence on RFS and CSS with or without robotic assistance, but it was still linked to worse OS (combined HR; 2.54 95% CI: 1.18, 5.47). Furthermore, the subgroup analysis with intraoperative blood loss lower than 800 ML revealed that PBT had no substantial impact on OS and CSS of postoperative RCC patients, whereas it was correlated with poor RFS (1.42, 95% CI: 1.02-1.97).
CONCLUSIONS
RCC patients undergoing PBT after nephrectomy had poorer survival.
SYSTEMATIC REVIEW REGISTRATION
https://www.crd.york.ac.uk/PROSPERO/, identifier CRD42022363106.
PubMed: 36874080
DOI: 10.3389/fonc.2023.1092734