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Perioperative, functional, and oncologic outcomes of minimally-invasive surgery for highly complex renal tumors (RENAL or PADUA score ≥ 10): an evidence-based analysis

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Abstract

The primary objective of the current study is to undertake a comparative analysis of the effectiveness and safety of minimally-invasive partial nephrectomy (MIPN; including laparoscopic and robotic approaches) and open partial nephrectomy (OPN) for the treatment of highly complex renal tumors (defined as PADUA or RENAL score ≥ 10). A comprehensive search was conducted in four electronic databases (PubMed, Web of Science, Embase, and Cochrane Library) to identify relevant studies published in the English language up to April 2023. The current study employed Review Manager 5.4 and encompassed controlled trials of both MIPN and OPN for the treatment of highly complex renal tumors. This study comprised a total of eight comparative trials involving 1161 patients. MIPN demonstrated a significant reduction in length of hospital stay (weighted mean difference [WMD] − 2.08 days, 95% confidence interval [CI] − 2.48, − 1.68; p < 0.00001), blood loss (WMD − 39.86 mL, 95% CI − 75.32, − 4.39; p = 0.03), transfusion rates (odds ratio [OR] 0.30, 95% CI 0.13, 0.71; p = 0.006), and overall complications (OR 0.46, 95% CI 0.31, 0.70; p = 0.0003). However, there were no significant differences between MIPN and OPN in terms of operative time, warm ischemia time, conversion to radical nephrectomy rates, renal functional and oncologic outcomes. This study reveals that MIPN presents several benefits in comparison to OPN, including decreased length of hospital stay, blood loss, transfusion rates, and complications, while still offering renal functional and oncological outcomes that are comparable to those of OPN in patients with highly complex renal tumors.

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Funding

This study was supported by the National Natural Science Foundation of China (No. 82160146); Cuiying Scientific and Technological Innovation Program of Lanzhou University Second Hospital (Grant numbers CY2021-MS-A12 and CY2020- MS08 and 2020QN-09); Natural Science Foundation of Gansu Province of China (Grant numbers 21JR1RA151).

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Authors and Affiliations

  1. Department of Urology, Lanzhou University Second Hospital, Lanzhou, China

    Xiao-ran Li, Kun-peng Li, Jia-le Zuo, Wei Yang, Hao Tan, Wen-yun Wang, Si-yu Chen, Jun-hai Ma, Jun-sheng Bao & Zhong-jin Yue

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Contributions

Author contributions LX: Protocol development, data collection and management, methodology, data analysis and writing original draft. LK: Protocol development, data collection, data analysis, study supervision and writing original draft. ZJ: Protocol development, management and writing original draft. YW: Data analysis, methodology and writing original draft. TH: Data management and writing original draft. WW: Data management, methodology and writing original draft. CS: Data analysis, methodology and writing original draft. MJ: Protocol development, management, visualization and writing original draft. BS: Protocol development, management, visualization and writing original draft. YZ: Protocol development, visualization and writing original draft.

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Correspondence to Jun-hai Ma, Jun-sheng Bao or Zhong-jin Yue.

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11701_2023_1650_MOESM1_ESM.tif

Supplementary file1 Fig. S1 Funnel plot (A) operative time, (B) length of hospital stay, (C) blood loss, (D) overall complication (TIF 3758 KB)

Supplementary file2 (DOCX 16 KB)

Supplementary file3 (DOCX 18 KB)

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Li, Xr., Li, Kp., Zuo, Jl. et al. Perioperative, functional, and oncologic outcomes of minimally-invasive surgery for highly complex renal tumors (RENAL or PADUA score ≥ 10): an evidence-based analysis. J Robotic Surg 17, 1917–1931 (2023). https://doi.org/10.1007/s11701-023-01650-7

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