Robotic Versus Laparoscopic Partial Nephrectomy: A Systematic Review and Meta-Analysis

Aboumarzouk, Omar; Stein, Robert J.; Eyraud, Rémi; Haber, Georges-Pascal; Chłosta, Piotr; Somani, Bhaskar K.; Kaouk, Jihad

doi:10.1016/j.eururo.2012.06.038

Cited by 253 publications

(185 citation statements)

References 34 publications

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“…A prospective comparison of surgical outcomes obtained after robotic or pure laparoscopic PN in moderate to complex renal tumours showed significantly lower estimated blood loss and shorter WIT in the robotic group [59]. Meta-analyses of relatively small series found comparable perioperative outcomes and shorter WIT for robot-assisted PN [60]. In conclusion, PN can be performed, either with an open, pure laparoscopic, or robot-assisted approach, according to the surgeon's expertise and skills and equipment availability (LE 2b).…”

Section: Pn Techniquesmentioning

confidence: 99%

EAU Guidelines on Renal Cell Carcinoma: 2014 Update

Ljungberg¹,

Bensalah²,

Canfield³

et al. 2015

European Urology

2,677

1,914

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Context: The European Association of Urology Guideline Panel for Renal Cell Carcinoma (RCC) has prepared evidence-based guidelines and recommendations for RCC management. Objectives: To provide an update of the 2010 RCC guideline based on a standardised methodology that is robust, transparent, reproducible, and reliable. Evidence acquisition: For the 2014 update, the panel prioritised the following topics: percutaneous biopsy of renal masses, treatment of localised RCC (including surgical and nonsurgical management), lymph node dissection, management of venous thrombus, systemic therapy, and local treatment of metastases, for which evidence synthesis was undertaken based on systematic reviews adhering to Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. Relevant databases (Medline, Cochrane Library, trial registries, conference proceedings) were searched (January 2000 to November 2013) including randomised controlled trials (RCTs) and retrospective or controlled studies with a comparator arm. Risk of bias (RoB) assessment and qualitative and quantitative synthesis of the evidence were performed. The remaining sections of the document were updated following a structured literature assessment. Evidence synthesis: All chapters of the RCC guideline were updated. For the various systematic reviews, the search identified a total of 10 862 articles. A total of 151 studies reporting on 78 792 patients were eligible for inclusion; where applicable, data from RCTs were included and meta-analyses were performed. For RCTs, there was low RoB across studies; however, clinical and methodological heterogeneity prevented data pooling for most studies. The majority of studies included were retrospective with matched or unmatched cohorts based on single or multi-institutional data or national registries. The exception was for systemic treatment of metastatic RCC, in which several RCTs have been performed, resulting in recommendations based on higher levels of evidence.

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Section: Pn Techniquesmentioning

confidence: 99%

EAU Guidelines on Renal Cell Carcinoma: 2014 Update

Ljungberg¹,

Bensalah²,

Canfield³

et al. 2015

European Urology

2,677

1,914

View full text Add to dashboard Cite

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“…SE), appear to be unrelated to margins status, according to the largest currently available evidence. 7,[14][15][16][17][18] We aimed to evaluate the predictors of PSM after NSS for RCC in one of the largest available prospective multi-institutional studies.…”

Section: Introductionmentioning

confidence: 99%

A Prospective, Multicenter Evaluation of Predictive Factors for Positive Surgical Margins After Nephron-Sparing Surgery for Renal Cell Carcinoma: The RECORd1 Italian Project

Schiavina

Serni

Mari

et al. 2015

Clinical Genitourinary Cancer

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The early oncological goal of any partial nephrectomy (PN) is to achieve negative surgical margins (SMs). Several factors have been advocated as predictors of positive SMs (PSMs) after nephron-sparing surgery (NSS). In our study, age, upper pole tumor location, standard PN and Fuhrman 3/4 nuclear grade were found to be independent predictors of PSMs at multivariable analysis. Further evaluations are required to verify the oncological effect of the PSM on local and systemic recurrence. Background: The purpose of this study was to evaluate the predictors of positive margins in one of the largest available prospective multi-institutional studies. Patients and Methods: We evaluated all patients who underwent NSS for radiologically diagnosed kidney tumors between January 2009 and December 2012 at 19 urological Italian centers (Registry of Conservative Renal Surgery [RECORd] project). Preoperative and anthropometric data, comorbidities, intraoperative and postoperative outcomes, and histological findings were analyzed. The negative and PSMs were compared according to the clinical and surgical variables. Multivariable logistic regression models were applied to analyze predictors of PSMs. Results: Eight hundred consecutive patients were evaluated. Seven hundred sixty-one (95.1%) and 39 patients (4.9%) achieved negative and PSMs, respectively. Patients with PSMs were significantly older compared with those with negative margins (median age: 66.6 vs. 61.8 years, respectively; P ¼ .001). A higher incidence of PSMs was observed when NSS was performed for renal masses located in the upper pole (P ¼ .001). A lower rate of PSMs was found in patients treated with simple enucleation rather than standard PN (1.6% vs. 7.4%, respectively; P < .0001). A greater incidence of PSMs was found in Fuhrman 3/4 tumors (11.3%; P < .0001). At multivariable analysis, age (odds ratio [OR], 1.04; P ¼ .01), upper pole tumor location (OR, 2.85; P ¼ .005), standard PN (OR, 3.45; P ¼ .004), and Fuhrman 3-4 nuclear grade (OR, 4.81; P ¼ .001) were found to be independent predictors of PSMs. Conclusion: In our multi-institutional report, young age, simple enucleation, middle or lower tumor location, and low-grade tumor were demonstrated to be independent predictors of negative SMs.

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“…Thus, RALPN has been associated with more favourable warm ischemia time (WIT) or lower risk of conversion to radical nephrectomy as compared to the pure laparoscopic procedure. [8][9][10][11] This outcome has led to an increased use of robotic technology for partial nephrectomy indications at the expense of open procedures over the last few years. 12 An expanding range of indications for RALPN towards more complex renal masses has also been highlighted in experienced teams with good surgical outcomes.…”

Section: Introductionmentioning

confidence: 99%

Robot-assisted laparoscopic partial nephrectomy: Early single Canadian institution experience

Ploussard

Haddad²,

Kovac³

et al. 2013

CUAJ

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Background: Although robot-assisted partial nephrectomy (RALPN) has been increasingly adopted, open procedures continue to be the reference nephron-sparing technique. We describe our initial surgical outcomes of RALPN in our single institution robotic program. Methods: Between January 2011 and February 2013, 65 consecutive patients underwent a RALPN by 2 surgeons. Preoperative characteristics, including the R.E.N.A.L. nephrometry score, perioperative parameters, and postoperative course, including renal function, were assessed from a retrospective database. The mean follow-up was 12 months. Results: The mean age was 60.2 years and the mean tumour size was 3.9 cm. According to the R.E.N.A.L. nephrometry score, the tumours were classified moderately and highly complex tumours in 51% and 18.5% of cases, respectively. Median warm ischemia time (WIT) was 21 minutes. Factors associated with WIT were R.E.N.A.L. nephrometry score, tumour size, complication rates and surgeon experience. No conversion or grade 4 to 5 complications were reported. The mean hospital stay was 3 days. The overall complication rate was 24.6% (re-admission rate 7.7%), and decreased to 12% after 20 cases. After these initial 20 cases, a trifecta rate (no margins, preserved renal function, no complications) of 64.3% was achieved in moderately and highly complex tumours. The mean change in estimated glomerular filtration rate was 6.7 mL/ min without severe postoperative renal failure. Interpretation: RALPN is a safe and feasible procedure with low specific morbidity, even in moderately or highly complex renal masses. The WIT depends on tumour characteristics, mainly determined by the R.E.N.A.L. nephrometry score and is improved by surgeon experience. Longer follow-up is needed to assess the oncologic mid-term safety of the procedure.

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Robotic Versus Laparoscopic Partial Nephrectomy: A Systematic Review and Meta-Analysis

Cited by 253 publications

References 34 publications

EAU Guidelines on Renal Cell Carcinoma: 2014 Update

EAU Guidelines on Renal Cell Carcinoma: 2014 Update

A Prospective, Multicenter Evaluation of Predictive Factors for Positive Surgical Margins After Nephron-Sparing Surgery for Renal Cell Carcinoma: The RECORd1 Italian Project

Robot-assisted laparoscopic partial nephrectomy: Early single Canadian institution experience

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