Comparison between minimally invasive partial nephrectomy and open partial nephrectomy for complex renal tumors: a systematic review and meta-analysis

Abstract

Background: The present study aimed to conduct a pooled analysis to compare the efficacy and safety of minimally invasive partial nephrectomy (MIPN) with open partial nephrectomy (OPN) in patients with complex renal tumors (defined as PADUA or RENAL score ≥7). Methods: The present study followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement, Supplemental Digital Content 1, http://links.lww.com/JS9/A394. We conducted a systematic search of the PubMed, Embase, Web of Science, and Cochrane Library databases until October 2022. MIPN and OPN-controlled trials for complex renal tumors were included. The primary outcomes were perioperative results, complications, renal function, and oncologic outcomes. Results: A total of 2405 patients were included in 13 studies. MIPN outperformed OPN in terms of hospital stay [weighted mean difference (WMD) −1.84 days, 95% CI −2.35 to −1.33; P<0.00001], blood loss (WMD −52.42 ml, 95% CI −71.43 to −33.41; P<0.00001), transfusion rates [odds ratio (OR) 0.34, 95% CI 0.17–0.67; P=0.002], major complications (OR 0.59, 95% CI 0.40–0.86; P=0.007) and overall complications (OR 0.43, 95% CI 0.31–0.59; P<0.0001), while operative time, warm ischemia time, conversion to radical nephrectomy rates, estimated glomerular decline, positive surgical margins, local recurrence, overall survival, recurrence-free survival, and cancer-specific survival were not significantly different. Conclusions: The present study demonstrated that MIPN was associated with a shorter length of hospital stay, less blood loss, and fewer complications in treating complex renal tumors. MIPN may be considered a better treatment for patients with complex tumors when technically feasible.

Minimally invasive versus open partial nephrectomy for complex renal tumors: insights and limitation

“…The authors found that MIPN was associated with a significantly shorter length of hospital stay compared to OPN, with a weighted mean difference of −1.84 days 1 . This is an important finding, as reducing hospital stays can optimize healthcare resource utilization.…”

“…We read with interest the recent meta-analysis by Li et al . 1 comparing minimally invasive partial nephrectomy (MIPN) to open partial nephrectomy (OPN) for complex renal tumors. The authors performed a systematic review and meta-analysis comparing MIPN and OPN for treating complex renal tumors 1 .…”

“… 1 comparing minimally invasive partial nephrectomy (MIPN) to open partial nephrectomy (OPN) for complex renal tumors. The authors performed a systematic review and meta-analysis comparing MIPN and OPN for treating complex renal tumors 1 . The key findings of this comprehensive analysis were that MIPN was associated with shorter hospital stays, less blood loss, and fewer complications than OPN.…”

“…Second, there was a significant heterogeneity in the length of hospital stay ( I 2 =91%). Although the authors conducted subgroup analyses using a surgical approach, significant heterogeneity remained 1 . As heterogeneity may sometimes be difficult to explore, further analysis using prediction intervals can provide additional insight 2 .…”

“…A 95% prediction interval indicates the range that would contain the true effect in 95% of identical meta-analyses 2 . To address this knowledge gap, we used the raw data from the original meta-analysis 1 to conduct a prediction interval with Comprehensive Meta-Analysis (Version 4, Biostat; Englewood, New Jersey, USA). The details are shown in Figure 1 .…”