Robotic versus Laparoscopic Partial Nephrectomy of Clinical Effect—A Meta-Analysis excluding Small Studies

Abstract

Context: Robotic partial nephrectomy (RPN) is rapidly increasing recently. Although it has some obvious advantages, the benefit of RPN over pure laparoscopic partial nephrectomy (LPN) is controversial. Objective: To evaluate and compare perioperative outcomes of RPN and LPN. Methods: We performed a literature search up to May 2018 including studies on large sample comparing robotic and laparoscopic partial nephrectomy and screened literatures according to inclusion and excluding criteria and extracted the data we needed. First we compared baseline data and tumor characteristics. And then we performed a Meta-analysis to evaluate safety, effectiveness and functional outcomes of robotic versus laparoscopic partial nephrectomy using mean difference (MD) and odd ratio (OR) respectively. Results: A total of 6371 patients were included from 23 studies. All studies were cohort studies with no randomization. Patients treated with robotic partial nephrectomy had a decreased likelihood of operative conversion (OR 0.28, P < 0.00001), any (Clavien 1 or greater) (OR 0.28, P = 0.003) and major (Clavien 3 or greater) (OR 0.63, P = 0.0008) complications, positive margins (PSM) (OR 0.60, P = 0.0003), and had shorter warm ischemia time (WIT) (MD −3.33, P = 0.0004), lower blood transfusion rate, shorter length of stay (LOS) (MD −0.38, P = 0.02), less estimated blood loss (EBL) (MD −44.75, P = 0.03). Both approaches had similar operative times (MD −12.07, P = 0.23) and postoperative change in estimated glomerular filtration rate (eGFR) (MD 0.49, P = 0.32). Conclusions: This updated Meta-analysis of cohort studies demonstrated that robotic partial nephrectomy confers a superior morbidity profile compared to laparoscopic partial nephrectomy in most of the examined perioperative outcomes.