A meta-analysis of perioperative, oncological, and functional outcomes of robot-assisted partial nephrectomy for completely endophytic and hilar lesions.

Background: This study aims to compare the perioperative, functional, and oncological outcomes of robot-assisted partial nephrectomy in complex renal masses (CRM) with non-CRM tumors.

Methods: A systematic literature review was conducted in PubMed, Embase, Web of Science, and Cochrane Library databases, following the PRISMA guidelines. The studies comparing RAPN outcomes between complex renal masses (CRM), specifically completely endophytic and hilar renal tumors, versus non-complex renal masses (non-CRM), which include non-endophytic, and non-hilar renal tumors.

Results: Twelve studies involving 8126 patients were analyzed. The results revealed CRM group increased operative time (Mean Difference [MD]: 14.35 min; 95% CI: 5.14-23.55; p = 0.002), higher blood loss (MD: 20.42 mL; 95% CI: 0.83-40.02; p = 0.041), and greater decline in estimated glomerular filtration rate (eGFR) (MD: 2.19 mL/min/1.73 m²; 95% CI: 0.59-3.78; p = 0.007). Major complications were significantly more frequent in the CRM group (OR: 1.57; 95% CI: 1.15-2.13; p = 0.004). However, no significant differences were observed in length of hospital stay, positive surgical margins (PSM), or local recurrence rates.

Conclusions: RAPN for CRM is associated with longer operative times, increased blood loss, greater decline in eGFR, and higher rates of major complications. However, oncological outcomes (PSM and local recurrence rates) are comparable to those for non-CRM. These findings suggest that RAPN remains a feasible option for treating CRM in experienced centers, provided that careful patient selection and preoperative planning are followed.