Abstract
ObjectiveTo compare efficacy and safety of laparoscopicnephrectomy (LN) versusopen nephrectomy (ON) in the management of autosomal dominant polycystic kidney disease (ADPKD), we conducted a systematic review and meta-analysis.MethodsA systematic search of the electronic databases PubMed, Scopus, and the Cochrane Library was performed up to October 2014.This systematic review was performed based on observational comparative studies that assessed the two techniques. The weighted mean difference (WMD) and risk ratio (RR), with their corresponding 95% confidence interval (CI), were calculated to compare continuous and dichotomous variables, respectively.ResultsSeven studies were identified, including 195 cases (118 LN / 77 ON). Although LN was associated with longer operative time (WMD 30.236, 95%CI 14.541 −45.932, P<0.001) and the specimen might not have been resected as heavy as the ON group (WMD -986.516, 95%CI -1883.24–-89.795, P = 0.031), patients in this group might benefit from a shorter length of hospital stay (WMD -3.576, 95%CI 4.976–-2.176, P <0.001), less estimated blood loss (WMD -180.245, 95%CI -317.939–-42.556, P = 0.010), and lower need of transfusion (RR 0.345, 95%CI 0.183–0.650, P = 0.001). The LN group also had less overall complications (RR 0.545, 95%CI 0.329–0.903, P = 0.018). The need of narcotic analgesics between the two groups might have no significant difference (WMD -54.66, 95%CI -129.76–20.44, P = 0.154).ConclusionLN for giant symptomatic ADPKD was feasible, safe and efficacious. Morbidity was significantly reduced compared with the open approach. For an experienced laparoscopist, LN might be a better alternative.
Highlights
Autosomal dominant polycystic kidney disease (ADPKD), a genetically heterogeneous disease in which 2 genes are involved, PKD1 and PKD2[1], is the fourth commonest cause of all cases of end stage renal disease [2].Approximate 50% of ADPKD patients require dialysis or renal transplantation by the age of 60[3], with a loss of 4.4–5.9 ml/min in the GFR[4]
LN was associated with longer operative time (WMD 30.236, 95%confidence interval (CI) 14.541 −45.932, P
The LN group had less overall complications (RR 0.545, 95%CI 0.329–0.903, P = 0.018)
Summary
Autosomal dominant polycystic kidney disease (ADPKD), a genetically heterogeneous disease in which 2 genes are involved, PKD1 (chromosome16p13.3) and PKD2 (chromosome 4q2123)[1], is the fourth commonest cause (approximate 10%) of all cases of end stage renal disease [2].Approximate 50% of ADPKD patients require dialysis or renal transplantation by the age of 60[3], with a loss of 4.4–5.9 ml/min in the GFR[4]. Enlarged nonfunctionalpolycystic kidneys may contribute to abdominal pain, hematuria, hemorrhage, hypertension and infection. In patients with end-stage renal disease who have a history of infected cysts and frequent hemorrhaging, it is generally accepted that nephrectomy can be undertaken for symptomatic relief of pain [8]. Nephrectomy before transplantation has been accepted[9], the timing and indication for nephrectomy in patients with ADPKD arestill controversial
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