Abstract
Background: The use of robot-assisted radical nephrectomy (RARN) for renal cell carcinoma (RCC) has increased in recent years, but the advantages of RARN over laparoscopic radical nephrectomy (LRN) remain controversial. This study aimed to compare the perioperative outcomes between RARN and LRN.Methods: We systematically searched the EMBASE, PubMed, Web of Science, and CNKI databases to identify eligible comparative studies. The parameters were perioperative outcomes including operating time (OT), estimated blood loss (EBL), length of stay (LOS), conversion rate, and complications. Stata 15.0 software was used for the meta-analysis.Results: Seven studies with 1,832 patients were included in the analysis. Among them, 532 underwent RARN and 840 underwent LRN for RCC. There were no significant differences in OT (weighted mean difference [WMD], 29.05; 95% confidence interval [CI], −0.31, 58.41; p = 0.05), EBL (WMD, −4.56; 95% CI, −29.79, 20.67; p = 0.72), LOS (WMD, −0.34; 95% CI, −0.68, 0.00; p = 0.05), conversion rate (WMD, 2.67; 95% CI, 0.68, 10.46; p = 0.05), transfusion rate (odds ratio [OR], 1.30; 95% CI, 0.74, 2.27; p = 0.36), intraoperative complications (OR, 1.13; 95% CI, 0.61, 2.12; p = 0.62), and postoperative complications (OR, 1.07; 95% CI, 0.68, 1.67; p = 0.62) between the two groups.Conclusion: RARN was not superior to LRN in patients with RCC in terms of perioperative outcomes. Before establishing conclusive clinical recommendations, high-quality prospective large-scale randomized controlled trials with long-term follow-up are needed.
Highlights
Renal cell carcinoma (RCC) is the most common genitourinary malignancy, with estimated 403,262 new cases and 175,098 associated deaths worldwide in 2018 (1)
In 2005, a new surgical procedure for Radical nephrectomy (RN) was performed by Klingler et al (6), known as robot-assisted radical nephrectomy (RARN)
The pooled analysis indicated no significant differences for operating time (OT) between RARN and pure laparoscopic RN (LRN), albeit at a greater heterogeneity (Figure 2A)
Summary
Renal cell carcinoma (RCC) is the most common genitourinary malignancy, with estimated 403,262 new cases and 175,098 associated deaths worldwide in 2018 (1). After the development of minimally invasive techniques, laparoscopic RN (LRN) has been considered an alternative to traditional open RN because it is associated with less trauma and fewer perioperative complications (4). In 2005, a new surgical procedure for RN was performed by Klingler et al (6), known as robot-assisted radical nephrectomy (RARN). RARN has been considered a safe and powerful procedure for nephrectomy by multiple institutions, and its use has increased significantly during the past decade (7). The use of robot-assisted radical nephrectomy (RARN) for renal cell carcinoma (RCC) has increased in recent years, but the advantages of RARN over laparoscopic radical nephrectomy (LRN) remain controversial. This study aimed to compare the perioperative outcomes between RARN and LRN
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