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Comparison of Outcomes Between Transperitoneal and Retroperitoneal Robotic Partial Nephrectomy: A Meta-Analysis Based on Comparative Studies

Authors
  • Zhu, Daqing1
  • Shao, Xue2
  • Guo, Gang3
  • Zhang, Nandong4
  • Shi, Taoping1
  • Wang, Yi5
  • Gu, Liangyou3
  • 1 Department of Urology, Hainan Hospital, Chinese PLA General Hospital, Sanya , (China)
  • 2 Department of Neurology, Hainan Hospital, Chinese PLA General Hospital, Sanya , (China)
  • 3 Department of Urology, Chinese PLA General Hospital, Beijing , (China)
  • 4 Department of Urology, Affiliated Hospital of Inner Mongolia University For Nationalities, Tongliao , (China)
  • 5 Department of Urology, The Second Affiliated Hospital of Hainan Medical College, Haikou , (China)
Type
Published Article
Journal
Frontiers in Oncology
Publisher
Frontiers Media SA
Publication Date
Jan 08, 2021
Volume
10
Identifiers
DOI: 10.3389/fonc.2020.592193
Source
Frontiers
Keywords
Disciplines
  • Oncology
  • Systematic Review
License
Green

Abstract

Background To compare perioperative, functional and oncological outcomes between transperitoneal robotic partial nephrectomy (TRPN) and retroperitoneal robotic partial nephrectomy (RRPN). Methods A literature searching of Pubmed, Embase, Cochrane Library and Web of Science was performed in August, 2020. Pooled odds ratios (ORs) or weighted mean differences (WMDs) with 95% confidence intervals (CIs) were estimated using fixed-effect or random-effect model. Publication bias was evaluated with funnel plots. Only comparative studies with matched design or similar baseline characteristics were included. Results Eleven studies embracing 2,984 patients were included. There was no significant difference between the two groups regarding conversion to open (P = 0.44) or radical (P = 0.31) surgery, all complications (P = 0.06), major complications (P = 0.07), warm ischemia time (P = 0.73), positive surgical margin (P = 0.87), decline in eGFR (P = 0.42), CKD upstaging (P = 0.72), and total recurrence (P = 0.66). Patients undergoing TRPN had a significant higher minor complications (P = 0.04; OR: 1.39; 95% CI, 1.01–1.91), longer operative time (P < 0.001; WMD: 21.68; 95% CI, 11.61 to 31.76), more estimated blood loss (EBL, P = 0.002; WMD: 40.94; 95% CI, 14.87 to 67.01), longer length of hospital stay (LOS, P < 0.001; WMD: 0.86; 95% CI, 0.35 to 1.37). No obvious publication bias was identified. Conclusion RRPN is more favorable than TRPN in terms of less minor complications, shorter operative time, less EBL, and shorter LOS. Methodological limitations of the included studies should be considered while interpreting these results.

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