Perioperative and Long-Term Outcomes of Robot-Assisted Partial Nephrectomy: A Systematic Review

Abstract

Background Adoption of the robotic surgical platform for small renal cancers has rapidly expanded, but its utility compared to other approaches has not been established. The objective of this review is to assess perioperative and long-term oncologic and functional outcomes of robot-assisted partial nephrectomy (RAPN) compared to laparoscopic partial nephrectomy (LPN) and open partial nephrectomy (OPN). Methods A search in PubMed, Embase, and Cochrane (2010-2019) was conducted. Of 3877 articles screened, 7 observational studies were included. Results RAPN was associated with 24-50 mL less intraoperative blood loss compared to LPN and 39-84 mL less than OPN. RAPN also demonstrated trends of other postoperative benefits, such as shorter length of stay and fewer major complications. Several studies reported better long-term functional kidney outcomes, but these findings were inconsistent. Recurrence and cancer-specific survival (CSS) were similar across groups. While RAPN had a 5-year CSS of 90.1%-97.9%, LPN and OPN had survival rates of 85.9%-86.9% and 88.5-96.3% respectively. Conclusions RAPN may be associated with a lower estimated blood loss and comparable long-term outcomes when compared to other surgical approaches. However, additional randomized or propensity matched studies are warranted to fully assess long-term functional kidney and oncologic outcomes.

Robot-Assisted Partial Nephrectomy Mid-Term Oncologic Outcomes: A Systematic Review

“…A recent meta-analysis, including seven studies with 2646 patients, that compared RAPN to OPN, showed that RAPN resulted in less estimated blood loss, shorter length of hospital stay, and fewer complications; but it was lacking data on oncologic outcomes [ 11 ]. While the most recent systematic review showed slightly higher cancer-specific survival (CSS) rates for RAPN, with a 5-year CSS of 90.1–97.9% for RAPN versus 85.9–86.9% for LPN and 88.5–96.3% for OPN, when only studies with matched-pair analysis were included [ 12 ].…”

Robotic Esophagectomy. A Systematic Review with Meta-Analysis of Clinical Outcomes

“…In fact, the three-dimensional view allowed a better visualization of the operative field and the EndoWrist ® technology with the seven-degrees movement of the robotic arms allows to perform more accurate movements in narrow space [ 11 , 12 ]. Even if robotic approach could be considered the gold standard only for the treatment of the prostate cancer, it has accumulated consensus in many surgical fields [ 13 , 14 , 15 , 16 ]. In the setting of minimally invasive esophagectomy, it was first introduced in 2003 by Kernstine et al [ 17 ], but controversies about the advantages of robotic approach have to be considered still an open issue.…”

Perioperative and long-term functional outcomes of robot-assisted versus open partial nephrectomy: A single-center retrospective study of a Japanese cohort

“…Recently, several high-quality observational studies comparing RAPN and OPN have been published [ [16] , [17] , [18] , [19] , [20] , [21] , [22] , [23] , [24] , [25] , [26] , [27] , [28] ]. However, to date, the differences in the outcomes of RAPN and OPN especially in Japanese populations remain unknown.…”