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Frontiers in Oncology 2023This study aims to perform a pooled analysis to compare the outcomes of robot-assisted partial nephrectomy (RAPN) between complex tumors (hilar, endophytic, or cystic)...
Perioperative, oncologic, and functional outcomes of robot-assisted partial nephrectomy for special types of renal tumors (hilar, endophytic, or cystic): an evidence-based analysis of comparative outcomes.
PURPOSE
This study aims to perform a pooled analysis to compare the outcomes of robot-assisted partial nephrectomy (RAPN) between complex tumors (hilar, endophytic, or cystic) and non-complex tumors (nonhilar, exophytic, or solid) and evaluate the effects of renal tumor complexity on outcomes in patients undergoing RAPN.
METHODS
Four databases were systematically searched, including Science, PubMed, Web of Science, and Cochrane Library, to identify relevant studies published in English up to December 2022. Review Manager 5.4 was used for statistical analyses and calculations. The study was registered with PROSPERO (Registration number: CRD42023394792).
RESULTS
In total, 14 comparative trials, including 3758 patients were enrolled. Compared to non-complex tumors, complex tumors were associated with a significantly longer warm ischemia time (WMD 3.67 min, 95% CI 1.78, 5.57; p = 0.0001), more blood loss (WMD 22.84 mL, 95% CI 2.31, 43.37; p = 0.03), and a higher rate of major complications (OR 2.35, 95% CI 1.50, 3.67; p = 0.0002). However, no statistically significant differences were found between the two groups in operative time, length of stay, transfusion rates, conversion to open nephrectomy and radical nephrectomy rates, estimated glomerular filtration rate (eGFR) decline, intraoperative complication, overall complication, positive surgical margins (PSM), local recurrence, and trifecta achievement.
CONCLUSIONS
RAPN can be a safe and effective procedure for complex tumors (hilar, endophytic, or cystic) and provides comparable functional and oncologic outcomes to non-complex tumors.
SYSTEMATIC REVIEW REGISTRATION
https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=394792, identifier CRD42023394792.
PubMed: 37152053
DOI: 10.3389/fonc.2023.1178592 -
Frontiers in Oncology 2023The primary aim of this present study is to undertake a comprehensive comparative analysis of the perioperative, functional, and oncologic outcomes associated with...
Perioperative, functional, and oncologic outcomes of laparoscopic partial nephrectomy versus open partial nephrectomy for complex renal tumors: a systematic review and meta-analysis.
BACKGROUND
The primary aim of this present study is to undertake a comprehensive comparative analysis of the perioperative, functional, and oncologic outcomes associated with laparoscopic partial nephrectomy (LPN) and open partial nephrectomy (OPN) as interventions for the treatment of complex renal tumors, defined as PADUA or RENAL score ≥ 7.
METHODS
We systematically carried out an extensive search across four electronic databases, namely PubMed, the Cochrane Library, Embase, and Web of Science. Our objective was to identify pertinent studies published in the English language up to December 2023, and encompassed controlled trials comparing LPN and OPN as interventions for complex renal tumors.
RESULTS
This study encompassed a total of seven comparative trials, involving 934 patients. LPN exhibited a noteworthy reduction in the length of hospital stay (weighted mean difference [WMD] -2.06 days, 95% confidence interval [CI] -2.62, -1.50; p < 0.00001), blood loss (WMD -34.05mL, 95% CI -55.61, -12.48; p = 0.002), and overall complications (OR 0.38, 95% CI 0.19, 0.79; p = 0.009). However, noteworthy distinctions did not arise between LPN and OPN concerning parameters such as warm ischemia time, renal function, and oncological outcomes.
CONCLUSIONS
This study reveals that LPN presents several advantages over OPN. These benefits encompass a shortened hospital stay, diminished blood loss, and a reduced incidence of complications. Importantly, LPN achieves these benefits while concurrently upholding comparable renal function and oncological outcomes.
SYSTEMATIC REVIEW REGISTRATION
https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=457716, identifier CRD42023453816.
PubMed: 38273858
DOI: 10.3389/fonc.2023.1283935 -
Asian Journal of Surgery Jan 2024To evaluate the outcomes of robot-assisted partial nephrectomy (RAPN) for solid and cystic renal tumors. We systematically searched the Cochrane Library, PubMed, EMBASE,... (Review)
Review
To evaluate the outcomes of robot-assisted partial nephrectomy (RAPN) for solid and cystic renal tumors. We systematically searched the Cochrane Library, PubMed, EMBASE, and Scopus databases up to March 2023. Review Manager 5.4 performed a pooled analysis of the data for random effects. Besides, sensitivity and subgroup analyses to explore heterogeneity, Newcastle-Ottawa scale, and GRADE to evaluate study quality and level of evidence. Five observational studies comprising 1353 patients (Cystic tumor: 183; Solid tumor: 1083) were included in this study. Compared to solid masses, cystic masses were associated with fewer major complications (odds ratio [OR] = 2.2; 95% confidence intervals [CI] = 1.17 to 4.13; p = 0.01). Additionally, no significant differences were observed between the two groups in terms of operative time, warm ischemia time, blood loss, hospital stay, intraoperative complications, postoperative complications, transfusion rate, postoperative estimated glomerular filtration rate (eGFR), eGFR preservation, positive surgical margin (PSM), recurrence, overall survival (OS), cancer-specific survival (CSS), recurrence-free survival (RFS) and trifecta achievement. RAPN can be performed in cystic renal tumors with perioperative, functional, and oncologic outcomes like those achievable in solid tumors. However, our findings need further validation in a large-sample prospective randomized study.
Topics: Humans; Robotics; Prospective Studies; Treatment Outcome; Robotic Surgical Procedures; Kidney Neoplasms; Nephrectomy; Laparoscopy; Retrospective Studies; Observational Studies as Topic; Randomized Controlled Trials as Topic
PubMed: 37597984
DOI: 10.1016/j.asjsur.2023.08.048 -
Annals of the Royal College of Surgeons... Jan 2023Renal transplantation remains the definitive treatment for end-stage renal disease. Currently employed minimally invasive techniques include robotic-assisted laparoscopy... (Meta-Analysis)
Meta-Analysis
INTRODUCTION
Renal transplantation remains the definitive treatment for end-stage renal disease. Currently employed minimally invasive techniques include robotic-assisted laparoscopy and laparoscopy. This study aims to determine whether either method provides an advantage.
METHODS
Following PRISMA guidelines, a systematic review was conducted. Data were analysed using Review Manager 5.3.
RESULTS
A total of 12 studies were included. Operative time and operative bleeding were similar between both approaches, with a mean difference (MD) of 16min (95% confidence interval (CI) -4.06, 37.38; = 0.11) and 10.44ml (95% CI -43.89, 64.78; = 0.71), respectively. Robotics had longer warm ischemia time (MD 1.14min; 95% CI 0.65, 1.63; = 0.00001) but reduced length of stay (LOS) (MD -0.23days; 95% CI -0.45, -0.01; = 0.04) and pain (MD -1.26 VAS; 95% CI -1.77, 0.75). Similar complication and conversion rates were seen among groups.
CONCLUSIONS
Robotic approaches provide a viable alternative to laparoscopic surgery. Operative time, bleeding volumes, complications and conversion rates are similar between both techniques; apparent robotic advantages on LOS and Pain need to be better analysed by future studies.
Topics: Humans; Kidney Transplantation; Living Donors; Nephrectomy; Laparoscopy; Pain; Robotic Surgical Procedures; Treatment Outcome
PubMed: 35616429
DOI: 10.1308/rcsann.2021.0357 -
Frontiers in Oncology 2020To compare perioperative, functional and oncological outcomes between transperitoneal robotic partial nephrectomy (TRPN) and retroperitoneal robotic partial nephrectomy...
BACKGROUND
To compare perioperative, functional and oncological outcomes between transperitoneal robotic partial nephrectomy (TRPN) and retroperitoneal robotic partial nephrectomy (RRPN).
METHODS
A literature searching of Pubmed, Embase, Cochrane Library and Web of Science was performed in August, 2020. Pooled odds ratios (ORs) or weighted mean differences (WMDs) with 95% confidence intervals (CIs) were estimated using fixed-effect or random-effect model. Publication bias was evaluated with funnel plots. Only comparative studies with matched design or similar baseline characteristics were included.
RESULTS
Eleven studies embracing 2,984 patients were included. There was no significant difference between the two groups regarding conversion to open (P = 0.44) or radical (P = 0.31) surgery, all complications (P = 0.06), major complications (P = 0.07), warm ischemia time (P = 0.73), positive surgical margin (P = 0.87), decline in eGFR (P = 0.42), CKD upstaging (P = 0.72), and total recurrence (P = 0.66). Patients undergoing TRPN had a significant higher minor complications (P = 0.04; OR: 1.39; 95% CI, 1.01-1.91), longer operative time (P < 0.001; WMD: 21.68; 95% CI, 11.61 to 31.76), more estimated blood loss (EBL, P = 0.002; WMD: 40.94; 95% CI, 14.87 to 67.01), longer length of hospital stay (LOS, P < 0.001; WMD: 0.86; 95% CI, 0.35 to 1.37). No obvious publication bias was identified.
CONCLUSION
RRPN is more favorable than TRPN in terms of less minor complications, shorter operative time, less EBL, and shorter LOS. Methodological limitations of the included studies should be considered while interpreting these results.
PubMed: 33489891
DOI: 10.3389/fonc.2020.592193 -
Cancers Apr 2024The Mayo Adhesive Probability (MAP) score is a radiographic scoring system that predicts the presence of adherent perinephric fat (APF) during partial nephrectomies... (Review)
Review
The Mayo Adhesive Probability (MAP) score is a radiographic scoring system that predicts the presence of adherent perinephric fat (APF) during partial nephrectomies (PNs). The purpose of this systematic review is to summarize the current literature on the application of the MAP score for predicting intraoperative difficulties related to APF and complications in laparoscopic PNs. Three databases, PubMed, Scopus and Cochrane, were screened, from inception to 29 October 2023, taking into consideration the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) Guidelines. All the inclusion criteria were met by eight studies. The total operative time was around two hours in most studies, while the warm ischemia time was <30 min in all studies and <20 min in four studies. Positive surgical margins, conversion and transfusion rates ranged from 0% to 6.3%, from 0% to 5.0% and from 0.7% to 7.5%, respectively. Finally, the majority of the complications were classified as Grade I-II, according to the Clavien-Dindo Classification System. The MAP score is a useful tool for predicting not only the presence of APF during laparoscopic PNs but also various intraoperative and postoperative characteristics. It was found to be significantly associated with an increased operative time, estimated blood loss and intraoperative and postoperative complication rates.
PubMed: 38672537
DOI: 10.3390/cancers16081455 -
International Journal of Surgery... Feb 2024This study employs a meta-analytic approach to investigate the impact of robotic-assisted partial nephrectomy, with and without near-infrared fluorescence imaging... (Meta-Analysis)
Meta-Analysis
Comparison of perioperative outcomes of selective arterial clipping guided by near-infrared fluorescence imaging using indocyanine green versus undergoing standard robotic-assisted partial nephrectomy: a systematic review and meta-analysis.
BACKGROUND
This study employs a meta-analytic approach to investigate the impact of robotic-assisted partial nephrectomy, with and without near-infrared fluorescence imaging (NIRF-RAPN vs S-RAPN), on patients' perioperative outcomes and postoperative changes in renal function.
MATERIALS AND METHODS
The authors conducted a comprehensive and rigorous systematic review and cumulative meta-analysis of primary outcomes following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses), AMSTAR (Assessing the Methodological Quality of Systematic Reviews) Guidelines, and Risk-of-Bias Tool (RoB2). To ensure a thorough search, the authors systematically searched five major databases, including Medline, PubMed, Cochrane Library, Scopus, and Web of Science, from databases' inception to April 2023.
RESULTS
No significant differences were found between the two groups in terms of age ( P =0.19), right side ( P =0.54), BMI ( P =0.39), complexity score ( P =0.89), tumor size ( P =0.88), operating time ( P =0.39), estimated blood loss ( P =0.47), length of stay ( P =0.87), complications ( P =0.20), transfusion ( P =0.36), and positive margins ( P =0.38). However, it is noteworthy that the NIRF-RAPN group exhibited significant reductions in warm ischemia time ( P =0.001), the percentage change in estimated glomerular filtration rate at discharge ( P =0.01) compared to the S-RAPN group.
CONCLUSION
This meta-analysis provides evidence that the group undergoing NIRF-RAPN showed a statistically significant protective effect on the estimated glomerular filtration rate (eGFR).
Topics: Humans; Robotic Surgical Procedures; Kidney Neoplasms; Indocyanine Green; Treatment Outcome; Nephrectomy; Retrospective Studies
PubMed: 38000056
DOI: 10.1097/JS9.0000000000000924