Trans-peritoneal vs. retroperitoneal robotic assisted partial nephrectomy in posterior renal tumours: need for a risk-stratified patient individualised approach. A systematic review and meta-analysis
- 14 May 2019
- journal article
- review article
- Published by Springer Science and Business Media LLC in Journal of Robotic Surgery
- Vol. 14 (1), 1-9
- https://doi.org/10.1007/s11701-019-00973-8
Abstract
To systematically review world literature and compare peri-operative outcome including operating time (OT), estimated blood loss (EBL), warm ischemia time (WIT), length of stay (LOS) and complications between retroperitoneal robotic assisted partial nephrectomy (RP-RAPN) and trans-peritoneal robotic assisted partial nephrectomy (TP-RAPN) for posteriorly located renal masses. All randomised trials and observational studies comparing RP-RAPN and TP-RAPN for posteriorly located renal masses were considered. The GRADE approach (Grading of Recommendations Assessment, Development and Evaluation, GRADE) was used to rate the quality of evidence. 82 potential publications were identified. 3 were included in the review. All three studies were observational comparative studies. 347 and 550 patients underwent RP-RAPN and TP-RAPN, respectively, for posteriorly located tumours. There was statistically significant difference in LOS between the 2 techniques, favouring the RP-RAPN cohort: risk ratio (M-H, random, 95% CI), - 0.42 [- 0.67, - 0.18], p < 0.0006. There was no statistically significant difference in overall complication rates between the two techniques: risk ratio (M-H, fixed, 95% CI), 0.80 [0.49, 1.30], p = 0.37. There was no statistically significant difference in >= Clavien 3a complication rates between the two t echniques: risk ratio (M-H, fixed, 95% CI), 1.17 [0.62, 2.19], p = 0.63. OT, EBL, WIT and positive margin rates were similar for both approaches. The quality of evidence for complications, LOS and remaining outcomes were 'moderate', 'low' and 'very low', respectively, on GRADE approach. The current review suggests that the LOS with RP-RAPN are significantly lesser than TP-RAPN for posterior tumours. The RP-RAPN does not appear to offer any advantage over TP-RAPN for other peri-operative outcomes such as WIT, OT and EBL. The surgical margin rates and morbidity between the two approaches appear to be similar.Keywords
This publication has 19 references indexed in Scilit:
- Short-term Outcomes and Costs Following Partial Nephrectomy in England: A Population-based StudyEuropean Urology Focus, 2017
- Robotic Partial Nephrectomy for Posterior Tumors Through a Retroperitoneal Approach Offers Decreased Length of Stay Compared with the Transperitoneal Approach: A Propensity-Matched AnalysisJournal of Endourology, 2017
- Transperitoneal versus retroperitoneal robot-assisted partial nephrectomy: A systematic review and meta-analysisInternational Journal of Surgery, 2016
- Health resource use after robot‐assisted surgery vs open and conventional laparoscopic techniques in oncology: analysis of English secondary care data for radical prostatectomy and partial nephrectomyBJU International, 2016
- Retroperitoneal Robot-Assisted Partial Nephrectomy for Posterior Renal Masses Is Associated with Earlier Hospital Discharge: A Single-Institution Retrospective ComparisonJournal of Endourology, 2015
- Transperitoneal versus retroperitoneal robotic partial nephrectomy: matched-pair comparisons by nephrometry scoresWorld Journal of Urology, 2014
- Comparison of the Transperitoneal and Retroperitoneal Approach in Robot-Assisted Partial Nephrectomy in an Initial Case Series in JapanJournal of Endourology, 2013
- Robot-Assisted Partial Nephrectomy: A Comparison of the Transperitoneal and Retroperitoneal ApproachesJournal of Endourology, 2013
- Cognitive-behavioural interventions for children who have been sexually abusedEmergencias, 2012
- GRADE: an emerging consensus on rating quality of evidence and strength of recommendationsBMJ, 2008