Nikolaos Grivas1,2, Nikolaos Kalampokis3, Alessandro Larcher4,5,6, Stavros Tyritzis7,8, Koon H Rha9, Vincenzo Ficarra10, Nicoló Buffi11, Achilles Ploumidis12, Riccardo Autorino13, Francesco Porpiglia14, Henk van der Poel15, Alexandre Mottrie4,5, Geert de Naeyer4. 1. Department of Urology, Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands - nikolaosgrivas@hotmail.com. 2. Department of Urology, G. Hatzikosta General Hospital, Ioannina, Greece - nikolaosgrivas@hotmail.com. 3. Department of Urology, G. Hatzikosta General Hospital, Ioannina, Greece. 4. Department of Urology, OLV, Aalst, Belgium. 5. ORSI Academy, Melle, Belgium. 6. Division of Oncology, Unit of Urology, URI, San Raffaele IRCCS Hospital, Milan, Italy. 7. Section of Urology, Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden. 8. Center for Minimally Invasive Urological Surgery, Athens Medical Center, Athens, Greece. 9. Department of Urology and Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea. 10. Section of Urology, Gaetano Barresi Department of Human and Pediatric Pathology, University of Messina, Messina, Italy. 11. Humanitas Clinical and Research Center, Humanitas University, Milan, Italy. 12. Department of Urology, Athens Medical Center, Athens, Greece. 13. Division of Urology, McGuire VAMC and VCU Health Center, Richmond, VA, USA. 14. Department of Urology, San Luigi Gonzaga Hospital, Orbassano, Turin, Italy. 15. Department of Urology, Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands.
Abstract
INTRODUCTION: Robot-assisted partial nephrectomy (RAPN) is increasingly used for the surgical management of renal masses. Aim of this study was to analyze the available literature regarding the outcomes of RAPN compared to those of open partial nephrectomy (OPN). EVIDENCE ACQUISITION: A literature search was performed up to October 2018 using PubMed, MEDLINE and Embase. Article selection followed the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) principles and Population, Intervention, Comparator, Outcomes (PICO) methodology was used. Population (P) was patients with renal masses who underwent RAPN (I). RAPN was compared with OPN (C). Outcomes of interest were perioperative, oncological and functional outcomes of both surgical procedures (O). Inclusion criteria were: randomized controlled studies andobservational cohort studies comparing RAPN versus OPN, which reported at least one outcome of interest. EVIDENCE SYNTHESIS: Twenty-two manuscripts met our inclusion criteria and were included in the systematic review. RAPN was superior to OPN in terms of complication rate in 11 studies while similar results were observed in 9 studies. Positive surgical margins were similar in 13 studies while RAPN had lower surgical margins in 6 studies. Operative and warm ischemia times were longer in OPN in 13 and 10 studies, respectively. Seventeen and 19 studies showed that estimated blood loss and length of hospital stay were higher in RAPN. Estimated glomerular filtration rate decline and chronic kidney disease upstaging decline were similar in the majority of studies. CONCLUSIONS: Current evidence demonstrate that RAPN is a reasonable alternative to OPN with regard to oncological and early functional outcomes with a straightforward advantage of improved perioperative morbidity, as expected by minimally invasive techniques. Nevertheless, there is still a great need for well-designed randomized studies with an extended follow-up.
INTRODUCTION: Robot-assisted partial nephrectomy (RAPN) is increasingly used for the surgical management of renal masses. Aim of this study was to analyze the available literature regarding the outcomes of RAPN compared to those of open partial nephrectomy (OPN). EVIDENCE ACQUISITION: A literature search was performed up to October 2018 using PubMed, MEDLINE and Embase. Article selection followed the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) principles and Population, Intervention, Comparator, Outcomes (PICO) methodology was used. Population (P) was patients with renal masses who underwent RAPN (I). RAPN was compared with OPN (C). Outcomes of interest were perioperative, oncological and functional outcomes of both surgical procedures (O). Inclusion criteria were: randomized controlled studies andobservational cohort studies comparing RAPN versus OPN, which reported at least one outcome of interest. EVIDENCE SYNTHESIS: Twenty-two manuscripts met our inclusion criteria and were included in the systematic review. RAPN was superior to OPN in terms of complication rate in 11 studies while similar results were observed in 9 studies. Positive surgical margins were similar in 13 studies while RAPN had lower surgical margins in 6 studies. Operative and warm ischemia times were longer in OPN in 13 and 10 studies, respectively. Seventeen and 19 studies showed that estimated blood loss and length of hospital stay were higher in RAPN. Estimated glomerular filtration rate decline and chronic kidney disease upstaging decline were similar in the majority of studies. CONCLUSIONS: Current evidence demonstrate that RAPN is a reasonable alternative to OPN with regard to oncological and early functional outcomes with a straightforward advantage of improved perioperative morbidity, as expected by minimally invasive techniques. Nevertheless, there is still a great need for well-designed randomized studies with an extended follow-up.
Authors: Lucas Teixeira Batista; José Guilherme Reis de Oliveira; Vitor Parente Gouvea; Leonardo Azevedo de Souza; Rafael Tourinho-Barbosa Journal: Acta Cir Bras Date: 2022-09-19 Impact factor: 1.564