腹腔镜和机器人辅助部分肾切除术治疗复杂肾肿瘤(肾评分≥7或最大肿瘤大小> 4cm)的疗效比较:系统综述和荟萃分析。

Q1 Medicine

Minerva Urologica E Nefrologica Pub Date : 2021-01-13 DOI:10.23736/S0393-2249.20.04135-1

Pengxiu Lin, Minhong Wu, Hong-li Gu, L. Tu, Shilan Liu, Zhiling Yu, Qingsheng Chen, Cailing Liu

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引用次数: 9

摘要

我们回顾了目前的研究，并进行了一项荟荟性分析，比较腹腔镜部分肾切除术(LPN)和机器人辅助部分肾切除术(RAPN)治疗复杂肾肿瘤(肾评分≥7或最大临床肿瘤大小> 4cm)的结果。证据获取利用PubMed、Embase和Cochrane图书馆的数据库，于2020年4月进行了全面的文献检索。采用固定效应或随机效应模型计算95%置信区间(ci)的合并优势比(ORs)或加权平均差异(wmd)。用漏斗图评价发表偏倚。证据综合:包括5193例患者的观察性研究(LPN: 1574;RAPN: 3619)。两组在转行开腹手术(P = 0.07)、所有并发症(P = 0.12)、1-2级并发症(P = 0.10)、3-5级并发症(P = 0.93)、手术时间(P = 0.94)、预计失血量(P = 0.17)方面差异无统计学意义。接受LPN的患者转化为根治性肿瘤的比率明显更高(OR: 4.33;95% ci: 2.01-9.33;p < 0.001)，缺血时间较长(IT, p < 0.001;WMD: 3.02分钟;95% CI, 1.67 ~ 4.36)，更长的住院时间(LOS, P < 0.001;大规模杀伤性武器:0.67天;95% CI, 0.35 ~ 0.99)，手术切缘阳性率较低(P = 0.03;OR: 0.71;95% CI, 0.53 ~ 0.96)， eGFR下降幅度较大(P < 0.001;WMD: 2.41 ml/min/1.73 m2;95% CI, 1.22 ~ 3.60)，较高的CKD占上风率(P < 0.001;OR: 2.44;95% CI, 1.54 ~ 3.87)。未观察到明显的发表偏倚。结论对于复杂的肾肿瘤，RAPN在转归根治性手术率较低、IT较短、LOS较短、eGFR下降较小、CKD前期率较低等方面优于LPN。在解释这些结果时应考虑观察性研究的方法学局限性。

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Comparison of outcomes between laparoscopic and robot-assisted partial nephrectomy for complex renal tumors (RENAL score ≥ 7 or maximum tumor size > 4cm): a systematic review and meta-analysis.

INTRODUCTION We reviewed current studies and performed a meta-analysis to compare outcomes between laparoscopic partial nephrectomy (LPN) and robot-assisted partial nephrectomy (RAPN) treating complex renal tumors (RENAL score ≥ 7 or maximum clinical tumor size > 4cm). EVIDENCE ACQUISITION Using the databases of PubMed, Embase, and the Cochrane Library, a comprehensive literature search was performed in April, 2020. Pooled odds ratios (ORs) or weighted mean differences (WMDs) with 95% confidence intervals (CIs) were calculated using fixed-effect or random-effect model. Publication bias was evaluated by funnel plots. EVIDENCE SYNTHESIS Ten observational studies including 5193 patients (LPN: 1574; RAPN: 3619) were included. There was no significant difference between the two groups regarding conversion to open (P = 0.07) surgery, all complications (P = 0.12), grade 1-2 complications (P = 0.10), grade 3-5 complications (P = 0.93), operative time (P = 0.94), estimated blood loss (P = 0.17). Patients undergoing LPN had a significant higher rate of conversion to radical (OR: 4.33; 95% CI: 2.01-9.33; p < 0.001), a longer ischemia time (IT, P < 0.001; WMD: 3.02 min; 95% CI, 1.67 to 4.36), a longer length of stay (LOS, P < 0.001; WMD: 0.67 days; 95% CI, 0.35 to 0.99), a lower rate of positive surgical margin (P = 0.03; OR: 0.71; 95% CI, 0.53 to 0.96), a greater eGFR decline (P < 0.001; WMD: 2.41 ml/min/1.73 m2; 95% CI, 1.22 to 3.60), a higher rate of CKD upstaging (P < 0.001; OR:2.44; 95% CI, 1.54 to 3.87). No obvious publication bias was observed. CONCLUSIONS For complex renal tumors, RAPN is more favorable than LPN in terms of lower rate of conversion to radical surgery, shorter IT, shorter LOS, less eGFR decline, and lower rate of CKD upstaging. Methodological limitations of observational studies should be taken into account in interpreting these results.

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来源期刊

Minerva Urologica E Nefrologica UROLOGY & NEPHROLOGY-

CiteScore

5.50

自引率

0.00%

发文量

审稿时长

>12 weeks

期刊介绍： The journal Minerva Urologica e Nefrologica publishes scientific papers on nephrology and urology. Manuscripts may be submitted in the form of Minerva opinion editorials, editorial comments, original articles, video illustrated articles, review articles and letters to the Editor.