Abstract
PurposeTo summarize and analyze the current evidence about surgical, oncological, and functional outcomes between laparoscopic partial nephrectomy (LPN) and open partial nephrectomy (OPN).Materials and MethodsThrough a systematical search of multiple scientific databases in March 2020, we performed a systematic review and cumulative meta-analysis. Meanwhile, we assessed the quality of the relevant evidence according to the framework in the Cochrane Handbook for Systematic Reviews of Interventions.ResultsA total of 26 studies with 8095 patients were included. There was no statistical difference between the LPN and OPN in the terms of operation time (p=0.13), intraoperative complications (p=0.94), recurrence (p=0.56), cancer-specific survival (p=0.72), disease-free survival (p=0.72), and variations of estimated glomerular filtration rate (p=0.31). The LPN group had significantly less estimated blood loss (P<0.00001), lower blood transfusion (p=0.04), shorter length of hospital stay (p<0.00001), lower total (p=0.03) and postoperative complications (p=0.02), higher positive surgical margin (p=0.005), higher overall survival (p<0.00001), and less increased serum creatinine (p=0.002). The subgroup analysis showed that no clinically meaningful differences were found for T1a tumors in terms of operation time (p=0.11) and positive surgical margin (p=0.23). In addition, the subgroup analysis also suggested that less estimated blood loss (p<0.0001) and shorter length of hospital stay (p<0.00001) were associated with the LPN group for T1a tumors.ConclusionsThis meta-analysis revealed that the LPN is a feasible and safe alternative to the OPN with comparable surgical, oncologic, and functional outcomes. However, the results should be applied prudently in the clinic because of the low quality of evidence. Further quality studies are needed to evaluate the effectiveness LPN and its postoperative quality of life compared with OPN.
Highlights
For T1 (≤7 cm) renal masses, partial nephrectomy (PN) is the preferred surgical treatment, which is suggested by guidelines [1,2,3]
863 studies were excluded that were irrelevant to our inclusion criteria by screening records
Some experienced centers report that shorter operative time has something to do with the laparoscopic PN (LPN), which proves that the LPN has a great potential to transcend the open PN (OPN) in terms of operative time for experienced centers [25, 39, 42, 43]
Summary
For T1 (≤7 cm) renal masses, partial nephrectomy (PN) is the preferred surgical treatment, which is suggested by guidelines [1,2,3]. PN is similar to radical nephrectomy in oncological safety [4, 5]. PN protects kidney function better and reduces the incidence of cardiovascular diseases [4, 6]. Laparoscopic PN (LPN) is an enormous technical challenge and has a steep learning curve, it is obviously becoming a feasible alternative to open PN (OPN) with less blood loss, fewer complications, and comparable oncologic and functional outcomes [7,8,9,10,11]. With the development of laparoscopic techniques, the robotic technique has been frequently reported [12, 13]. The LPN is the first choice for primarily experienced centers because of better cost-efficacy [16]
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