Abstract
Objective: The purpose of this meta-analysis was to systematically assess the influence of three-dimensional (3D) printing technology in laparoscopic partial nephrectomy (LPN) of complex renal tumors.Methods: A systematic literature review was performed in June 2020 using the Web of Science, PubMed, Embase, the Cochrane library, the China National Knowledge Infrastructure (CNKI), and the Wanfang Databases to identify relevant studies. The data relative to operation time, warm ischemic time, intraoperative blood loss, positive surgical margin, reduction in estimated glomerular filtration rate (eGFR), and complications (including artery embolization, hematoma, urinary fistula, transfusion, hematuria, intraoperative bleeding, and fever) were extracted. Two reviewers independently assessed the quality of all included studies, and the eligible studies were included and analyzed using the Stata 12.1 software. A subgroup analysis was performed stratifying patients according to the complexity of the tumor and surgery type or to the nephrometry score.Results: One randomized controlled trial (RCT), two prospective controlled studies (PCS), and seven retrospective comparative studies (RCS) were analyzed, involving a total of 647 patients. Our meta-analysis showed that there were significant differences in operation time, warm ischemic time, intraoperative blood loss, reduction in eGFR, and complications between the LPN with 3D-preoperative assessment (LPN-3DPA) vs. LPN with conventional 2D preoperative assessment (LPN-C2DPA) groups. Positive surgical margin did not differ significantly.Conclusion: The LPN-3DPA group showed shorter operation time and warm ischemic time, as well as less intraoperative blood loss, reduction in eGFR, fewer complications for patients with complex renal tumor. Therefore, LPN assisted by three-dimensional printing technology should be a preferable treatment of complex renal tumor when compared with conventional LPN. However, further large-scale RCTs are needed in the future to confirm these findings.
Highlights
With the advancement and widespread usage of image technology, low-stage and small renal tumors are being detected more often in recent years, which has partly contributed to the dramatically increased incidence of renal tumors [1]
Since partial nephrectomy (PN) achieves equivalent oncological prognosis and lower incidence of adverse outcomes in comparison with radical nephrectomy [2], PN has gradually been recognized as a standard treatment for patients with clinically localized renal cell carcinoma with tumor size
The Newcastle–Ottawa Scale was used to assess the risk of bias of the retrospective comparative studies (RCS) and prospective controlled studies (PCS), and the total scores of 5–9 indicated that the study was a low risk of bias (Table 3)
Summary
With the advancement and widespread usage of image technology, low-stage and small renal tumors are being detected more often in recent years, which has partly contributed to the dramatically increased incidence of renal tumors [1]. There are three methods for partial nephrectomy: open surgery, laparoscopy, and robot-assisted laparoscopy. With the advancement of technology, application of a robot-assisted surgery system has become a popular trend in the field of urology surgery. To define more complex lesions, including invisible feeding arteries and hilar or endophytic masses, conventional 2D preoperative assessment neither provides a sense of perspective nor does it facilitate these procedures [4]. With the more widespread application of 3D printing technology in the medical field, doctors can obtain physical anatomical models based on patients’ imaging data for preoperative assessment. A 3Dprinted model can be used to study complex cases, to simulate and practice operations, to teach students, and to educate patients [5]
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