Robotic versus Open Partial Nephrectomy: A Systematic Review and Meta-Analysis |
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Authors: | Zhenjie Wu Mingmin Li Bing Liu Chen Cai Huamao Ye Chen Lv Qing Yang Jing Sheng Shangqing Song Le Qu Liang Xiao Yinghao Sun Linhui Wang |
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Institution: | 1. Department of Urology, Changhai Hospital, Second Military Medical University, Shanghai, P. R. China.; 2. Department of Radiology, Changhai Hospital, Second Military Medical University, Shanghai, P. R. China.; 3. Department of Special Clinic, Changhai Hospital, Second Military Medical University, Shanghai, P. R. China.; H. Lee Moffitt Cancer Center & Research Institute, United States of America, |
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Abstract: | ObjectivesTo critically review the currently available evidence of studies comparing robotic partial nephrectomy (RPN) and open partial nephrectomy (OPN).Materials and MethodsA comprehensive review of the literature from Pubmed, Web of Science and Scopus was performed in October 2013. All relevant studies comparing RPN with OPN were included for further screening. A cumulative meta-analysis of all comparative studies was performed and publication bias was assessed by a funnel plot.ResultsEight studies were included for the analysis, including a total of 3418 patients (757 patients in the robotic group and 2661 patients in the open group). Although RPN procedures had a longer operative time (weighted mean difference WMD]: 40.89; 95% confidence interval CI], 14.39–67.40; p = 0.002), patients in this group benefited from a lower perioperative complication rate (19.3% for RPN and 29.5% for OPN; odds ratio OR]: 0.53; 95%CI, 0.42–0.67; p<0.00001), shorter hospital stay (WMD: −2.78; 95%CI, −3.36 to −1.92; p<0.00001), less estimated blood loss(WMD: −106.83; 95%CI, −176.4 to −37.27; p = 0.003). Transfusions, conversion to radical nephrectomy, ischemia time and estimated GFR change, margin status, and overall cost were comparable between the two techniques. The main limitation of the present meta-analysis is the non-randomization of all included studies.ConclusionsRPN appears to be an efficient alternative to OPN with the advantages of a lower rate of perioperative complications, shorter length of hospital stay and less blood loss. Nevertheless, high quality prospective randomized studies with longer follow-up period are needed to confirm these findings. |
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