Abstract
ObjectiveTo compare the efficiency and safety of the transperitoneal approaches with retroperitoneal approaches in laparoscopic partial nephrectomy for renal cell carcinoma and provide evidence-based medicine support for clinical treatment.MethodsA systematic computer search of PUBMED, EMBASE, and the Cochrane Library was executed to identify retrospective observational and prospective randomized controlled trials studies that compared the outcomes of the two approaches in laparoscopic partial nephrectomy. Two reviewers independently screened, extracted, and evaluated the included studies and executed statistical analysis by using software STATA 12.0. Outcomes of interest included perioperative and postoperative variables, surgical complications and oncological variables.ResultsThere were 8 studies assessed transperitoneal laparoscopic partial nephrectomy (TLPN) versus retroperitoneal laparoscopic partial nephrectomy (RLPN) were included. RLPN had a shorter operating time (SMD = 1.001,95%confidence interval[CI] 0.609–1.393,P<0.001), a lower estimated blood loss (SMD = 0.403,95%CI 0.015–0.791,P = 0.042) and a shorter length of hospital stay (WMD = 0.936 DAYS,95%CI 0.609–1.263,P<0.001) than TLPN. There were no significant differences between the transperitoneal and retroperitoneal approaches in other outcomes of interest.ConclusionsThis meta-analysis indicates that, in appropriately selected patients, especially patients with intraperitoneal procedures history or posteriorly located renal tumors, the RLPN can shorten the operation time, reduce the estimated blood loss and shorten the length of hospital stay. RLPN may be equally safe and be faster compared with the TLPN.
Highlights
Renal cell carcinoma (RCC) was thought to arise primarily from the proximal convoluted tubules and some histologic subtypes were from the more distal components of the nephron
RCC, which accounts for 2%–3% of all adult malignancies, with the highest incidence occurring in Western countries [1], is the most lethal of the urologic cancers
More than 40% of patients with RCC have died from their cancer, in contrast with the approximately 20% mortality rates associated with prostate and bladder carcinomas [2]
Summary
Renal cell carcinoma (RCC) was thought to arise primarily from the proximal convoluted tubules and some histologic subtypes were from the more distal components of the nephron. Due to the increased detection of tumors by imaging techniques, such as ultrasound and computed tomography, the number of incidentally diagnosed RCCs has increased, largely owing to a more prevalent use them for the evaluation of a variety of abdominal or gastrointestinal complaints [12]. These tumors are more often small, slow growth and of lower stage such as T1 [13].The nephron sparing surgery (NSS) can resects the localized tumors completely and retain the functional renal sections. We collected related literatures and made a meta-analysis to compare the efficiency and safety of the transperitoneal approaches with retroperitoneal approaches in laparoscopic partial nephrectomy for renal cell carcinoma
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