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Comparison of the perioperative outcomes of robot-assisted laparoscopic transperitoneal versus retraperitoneal partial nephrectomy for posterior-lateral renal tumors: a systematic review and meta-analysis

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Abstract

The study aims to assess the available literature and compare the perioperative outcomes of robotic-assisted partial nephrectomy (RAPN) for posterior-lateral renal tumors using transperitoneal (TP) and retroperitoneal (RP) approaches. Systematically searched the Embase, PubMed, and Cochrane Library databases for literature. Eligible studies were those that compared TP-RAPN and RP-RAPN for posterior-lateral renal tumors. The data from the included studies were analyzed and summarized using Review Manager 5.3, which involved comparing baseline patient and tumor characteristics, intraoperative and postoperative outcomes, and oncological outcomes. The analysis included five studies meeting the inclusion criteria, with a total of 1440 patients (814 undergoing RP-RAPN and 626 undergoing TP-RAPN). Both groups showed no significant differences in age, gender, BMI, R.E.N.A.L. score, and tumor size. Notably, compared to TP-RAPN, the RP-RAPN group demonstrated shorter operative time (OT) (MD: 17.25, P = 0.01), length of hospital stay (LOS) (MD: 0.37, P < 0.01), and lower estimated blood loss (EBL) (MD: 15.29, P < 0.01). However, no significant differences were found between the two groups in terms of warm ischemia time (WIT) (MD: -0.34, P = 0.69), overall complications (RR: 1.25, P = 0.09), major complications (the Clavien-Dindo classification ≥ 3) (RR: 0.97, P = 0.93), and positive surgical margin (PSM) (RR: 1.06, P = 0.87). The systematic review and meta-analysis suggests RP-RAPN may be more advantageous for posterior-lateral renal tumors in terms of OT, EBL, and LOS, but no significant differences were found in WIT, overall complications, major complications, and PSM. Both surgical approaches are safe, but a definitive advantage remains uncertain.

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All data generated or analyzed during this study are included in the article. Further inquiries can be directed to the corresponding author.

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Funding

This work was supported by the City of Nanchong Strategic Cooperation with the Local Universities Foundation of Technology (20SXQT0305 and 18SXHZ0321), the Application and Basic Research Program of the Sichuan Science and Technology Department (2020YJ0185 and 2022NSFSC0804), the Primary Health Development Research Center of Sichuan Province Program (SWFZ21-C-98), and the Medical Research Project of the Sichuan Medical Association (S21061).

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Authors and Affiliations

  1. Department of Urology, Affiliated Hospital of North Sichuan Medical College, No. 1 Maoyuan South Road,Shunqing, Nanchong, 637000, Sichuan, People’s Republic of China

    Pengjun Xu, Jia Luo, Hui Shuai, Tao Cai, Shu Cui, Lin Zhou, Qian Xu, Yuxin Zhao, Tao Chen & Tao Wu

  2. Department of Biomedical Engineering, Faculty of Engineering, The Hong Kong Polytechnic University, Hong Kong, China

    Wang Shan

  3. Department of Urology, Affiliated Hospital of North Sichuan Medical College, Wenhua Road 57, Shunqing District, Nanchong, 637000, Sichuan, People’s Republic of China

    Tao Wu

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  1. Pengjun Xu
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  2. Jia Luo
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  4. Tao Cai
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  9. Tao Chen
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Contributions

XPJ: project development; data analysis; manuscript writing. LJ: project development; data collection; manuscript writing. SH: data collection; manuscript writing. Cai Tao: manuscript editing. CS: manuscript editing. ZL: data analysis. XQ: data analysis. ZYX: data analysis. Tao chen: data analysis. WT: project development; supervision. All authors read and approved the final version of the manuscript.

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Correspondence to Tao Wu.

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Xu, P., Luo, J., Shuai, H. et al. Comparison of the perioperative outcomes of robot-assisted laparoscopic transperitoneal versus retraperitoneal partial nephrectomy for posterior-lateral renal tumors: a systematic review and meta-analysis. J Robotic Surg 18, 186 (2024). https://doi.org/10.1007/s11701-024-01963-1

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