Comparison of Laparoscopic and Open Partial Nephrectomy in the Treatment of T1 Renal Tumor:a Systematic Review and Meta-analysis

Abstract Objective:Different surgical approaches may bring different treatment results for one disease.We thus determined to gather the current evidence to evaluate the effect of laparoscopic partial nephrecomy(LPN) and open partial nephrectomy(OPN) in the treatment of T1 renal tumor.Methods:We comprehensively researched PubMed,Embase,Google Scholar and Clinicaltrials.gov to find all referring studies(published between Jan1,2015,and Jan 1,2020 without language restrictions) .We calculated the odds ratios(OR) and standard mean difference(SMD),and analyzed their heterogeneity with RevMan 5.3 software.Results:Six studies were included finally.Comparing open partial nephrectomy, the pooled SMD of operative time was 0.14, (95% confidential index CI = [-0.11, 0.38]), the pooled SMD of estimated blood loss was -0.14, (95% CI = [-0.58, 0.31]), the pooled SMD of ischemia time was 0.57, (95% CI = [-0.02, 1.16]), the pooled SMD of length of stay was -0.55, (95% CI = [-1.12, 0.02]),and the pooled OR of positive margin was 1.02, (95% CI = [0.39, 2.68]),the pooled OR of postoperative complications was 0.74,(95% CI = [0.41, 1.36]). Conclusions:LRN had advantages on decreasing postoperative complications rate but the ischemia time of OPN was much shorter.

Download Full-text

Comparison of the RENAL, PADUA, DAP, NePhRO, and SPARE scores for retroperitoneal laparoscopic partial nephrectomy.

10.21203/rs.3.rs-45284/v1 ◽

2020 ◽

Author(s):

Yanyang Jin ◽

Mingshuai Wang ◽

Feiya Yang ◽

Nianzeng Xing

Keyword(s):

Postoperative Complications ◽

Partial Nephrectomy ◽

Critical Role ◽

Laparoscopic Partial Nephrectomy ◽

Perioperative Outcomes ◽

High Grade ◽

Ischemia Time ◽

Imaging Results ◽

Estimated Blood Loss ◽

Clinical Records

Abstract Background: Nephrometry scores play a critical role in the preoperative evaluation of partial nephrectomy. Although score comparisons have been performed for transperitoneal or open surgery, systematic comparisons for retroperitoneal operations are lacking.Methods: We retrospectively evaluated the clinical records of patients who underwent partial nephrectomy at one center by one surgeon. Scores were generated according to the imaging results, and each score was categorized into low-, intermediate- and high-complexity groups. Then, the differences in perioperative outcomes were compared among the groups. We assessed whether the scores and sex, body mass index (BMI), age, or American Society of Anesthesiologists (ASA) Physical Status classification could predict whether the warm ischemia time (WIT) was likely be longer than 20 min and whether they could predict postoperative complications worse than Clavien–Dindo 1. The interobserver variability between two experienced surgeons for these scores was calculated with the intraclass correlation coefficient (ICC).Results: A total of 107 patients were ultimately evaluated. The median tumor size was 36.88 mm, and the median WIT, total operation time (OT) and estimated blood loss (EBL) were 18.97 min, 80 min, and 100 ml, respectively. Significant differences in WIT were identified among the complexity groups for each scoring system. Significant differences were identified between the OTs associated with the DAP and RENAL score complexity groups. The scores included in this study were significantly associated with the probability of having a WIT >20 min and high-grade postoperative complications. Receiver Characteristic Operator (ROC) curves showed that there were no significant differences in their predictive power. NePhRo had the highest agreement (0.839), followed by DAP (0.827). RENAL was superior to SPARE and PADUA, which were 0.758, 0.724 and 0.667, respectively.Conclusions: The scores included in this study were useful for preoperative assessment of retroperitoneal laparoscopic partial nephrectomy. No significant differences were observed among the scores in terms of their ability to predict prolonged hot ischemia time or high-grade postoperative complications. DAP is a good score in the retroperitoneal circumstance when its consistency is taken into account.

Download Full-text

Safety and Postoperative Outcomes of Regional versus Global Ischemia for Partial Nephrectomy: A Systematic Review and Meta-Analysis

Urologia Internationalis ◽

10.1159/000367997 ◽

2014 ◽

Vol 94 (4) ◽

pp. 428-435 ◽

Cited By ~ 1

Author(s):

Yiduo Wang ◽

Huan Qu ◽

Lei Zhang ◽

Shuqiu Chen ◽

Bin Xu ◽

...

Keyword(s):

Systematic Review ◽

Partial Nephrectomy ◽

Weighted Mean Difference ◽

Meta Analysis ◽

Global Ischemia ◽

Current Evidence ◽

Complication Rates ◽

Regional Ischemia ◽

Estimated Blood Loss ◽

Ischemia Group

Objective: To analyze current evidence comparing the safety and outcomes of regional and global ischemia for partial nephrectomy (PN). Materials and Methods: A systematic search of the PubMed and Web of Science databases was conducted in May 2014 to identify studies comparing the safety and outcomes of regional and global ischemia for PN. A systematic review and meta-analysis was also performed. Results: Six retrospective observational studies were selected for the analysis, including 363 patients who underwent PN (162 regional ischemia and 201 global ischemia cases). Operation times were not statistically different [weighted mean difference (WMD) = 20.35 min, 95% CI: -0.28-40.97, p = 0.05], but estimated blood loss was significantly higher in the regional ischemia group (WMD = 52.04 ml, 95% CI: 14.30-89.78, p = 0.007) than in the global ischemia group. Complication rates [odds ratio (OR) = 1.16; 95% CI: 0.63-2.15, p = 0.63] and blood transfusion rates (OR = 1.85; 95% CI: 0.86-4.01, p = 0.12) of the two groups were not significantly different. The regional ischemia group showed better postoperative renal function (WMD = 4.23 ml/min, 95% CI: 2.61-5.85, p < 0.00001) than the global ischemia group, and all cases in the regional ischemia group showed negative margins. Conclusions: Regional ischemia is as safe to perform as global ischemia, and the former leads to better postoperative renal functions than the latter. These findings support the application of regional ischemia for PN.

Download Full-text

Perioperative and Long-Term Outcomes of Robot-Assisted Partial Nephrectomy: A Systematic Review

The American Surgeon ◽

10.1177/0003134820948912 ◽

2020 ◽

pp. 000313482094891

Author(s):

Amber B. Tang ◽

Margherita Lamaina ◽

Christopher P. Childers ◽

Selene S. Mak ◽

Qiao Ruan ◽

...

Keyword(s):

Blood Loss ◽

Partial Nephrectomy ◽

Oncologic Outcomes ◽

Surgical Approaches ◽

Long Term Outcomes ◽

Robot Assisted ◽

Cancer Specific Survival ◽

Open Partial Nephrectomy ◽

Estimated Blood Loss

Background Adoption of the robotic surgical platform for small renal cancers has rapidly expanded, but its utility compared to other approaches has not been established. The objective of this review is to assess perioperative and long-term oncologic and functional outcomes of robot-assisted partial nephrectomy (RAPN) compared to laparoscopic partial nephrectomy (LPN) and open partial nephrectomy (OPN). Methods A search in PubMed, Embase, and Cochrane (2010-2019) was conducted. Of 3877 articles screened, 7 observational studies were included. Results RAPN was associated with 24-50 mL less intraoperative blood loss compared to LPN and 39-84 mL less than OPN. RAPN also demonstrated trends of other postoperative benefits, such as shorter length of stay and fewer major complications. Several studies reported better long-term functional kidney outcomes, but these findings were inconsistent. Recurrence and cancer-specific survival (CSS) were similar across groups. While RAPN had a 5-year CSS of 90.1%-97.9%, LPN and OPN had survival rates of 85.9%-86.9% and 88.5-96.3% respectively. Conclusions RAPN may be associated with a lower estimated blood loss and comparable long-term outcomes when compared to other surgical approaches. However, additional randomized or propensity matched studies are warranted to fully assess long-term functional kidney and oncologic outcomes.

Download Full-text

Hemostatic Agent May Improve Perioperative Outcomes in Partial Nephrectomy: A Systematic Review and Meta-Analysis

Urologia Internationalis ◽

10.1159/000518125 ◽

2021 ◽

pp. 1-8

Author(s):

Qiong Guo ◽

Yifei Lin ◽

Chenyang Zhang ◽

Yi Guo ◽

Youlin Long ◽

...

Keyword(s):

Postoperative Complications ◽

Partial Nephrectomy ◽

Operative Time ◽

Meta Analysis ◽

Sensitivity Analyses ◽

Perioperative Outcomes ◽

Estimated Blood Loss ◽

Subgroup Analyses

Background: Hemostatic agents (HAs) are used to achieve hemostasis and prevent postoperative complications in multiple surgeries, but the role of HAs is ambiguous during partial nephrectomy (PN), so this study aimed to assess the role of HAs in PN. Methods: PubMed, Embase, CENTRAL and ClinicalTrials.gov were searched for randomized controlled trials and cohort studies regarding the comparison of HA use alone and standard suturing during PN on January 17, 2020. RevMan 5.3 was used to conduct meta-analysis. Sensitivity analyses and subgroup analyses were performed based on surgical procedures and HA types. Results: Six studies involving 1,066 patients were included. The quality of studies was moderate to high. There were significant reductions in warm ischemia time (mean difference [MD] = −6.30 min, 95% confidence interval [CI] −7.70 to −4.90, p < 0.00001), operative time (MD = −19.81 min, 95% CI −27.54 to −12.08, p < 0.00001), and estimated blood loss (MD = −108.62 mL, 95% CI −177.27 to −39.9, p = 0.002) in the HA group, and HA use alone did not increase postoperative complications. The results were similar in the subgroup analyses and sensitivity analyses. Conclusion: HA may be an effective and safe surgical material in PN, which can improve postoperative outcomes. High-quality and randomly designed studies are needed to validate the applicability.

Download Full-text

Comparison of the effectiveness of sacrospinous ligament fixation and sacrocolpopexy: a meta-analysis

International Urogynecology Journal ◽

10.1007/s00192-021-04823-w ◽

2021 ◽

Author(s):

Wenju Zhang ◽

Willy Cecilia Cheon ◽

Li Zhang ◽

Xiaozhong Wang ◽

Yuzhen Wei ◽

...

Keyword(s):

Operative Time ◽

Meta Analysis ◽

Current Evidence ◽

Cochrane Library ◽

Surgical Approaches ◽

Sacrospinous Ligament ◽

Gastrointestinal Complications ◽

Sacrospinous Ligament Fixation ◽

Apical Support ◽

Abdominal Sacrocolpopexy

Abstract Introduction and hypothesis Sacrocolpopexy and sacrospinous ligament fixation (SSLF) have been used for the restoration of apical support. Studies comparing sacrocolpopexy and SSLF have reported conflicting results. We aim to assess the current evidence regarding efficiency and the complications of sacrocolpopexy compared with SSLF. Methods We searched PubMed, Embase, and Cochrane Library and performed a systematic review meta-analysis to assess the two surgical approaches. Results 5Five randomized controlled trials, 8 retrospective studies, and 2 prospective studies including 4,120 cases were identified. Compared with abdominal sacrocolpopexy (ASC), SSLF was associated with a lower success rate (88.32% and 91.45%; OR 0.52; 95% CI 0.29–0.95; p = 0.03), higher recurrence (11.58% and 8.32%; OR 1.97; 95% CI 1.04–3.46; p = 0.04), and dyspareunia rate (14.36% and 4.67%; OR 3.10; 95% CI 1.28–7.50; p = 0.01). Patients in this group may benefit from shorter operative time (weighted mean difference −25.08 min; 95% CI −42.29 to −7.88; p = 0.004), lower hemorrhage rate (0.85% and 2.58%; OR 0.45; 95% CI 0.25–0.85; p = 0.009), wound infection rate (3.30% and 5.76%; OR 0.55; 95% CI 0.39–0.77; p = 0.0005), and fewer gastrointestinal complications (1.33% and 6.19%; OR 0.33; 95% CI 0.15–0.76; p = 0.009). Conclusion Both sacrocolpopexy and SSLF offer an efficient alternative to the restoration of apical support. When anatomical durability and sexual function is a priority, ASC may be the preferred option. When considering factors of mesh erosion, operative time, gastrointestinal complications, hemorrhage, and wound infections, SSLF may be the better option.

Download Full-text

Laparoscopic versus open partial nephrectomy for the management of highly complex renal tumors with PADUA score ⩾10: A single center analysis.

Urologia Journal ◽

10.1177/03915603211001677 ◽

2021 ◽

pp. 039156032110016

Author(s):

Francesco Chiancone ◽

Marco Fabiano ◽

Clemente Meccariello ◽

Maurizio Fedelini ◽

Francesco Persico ◽

...

Keyword(s):

Partial Nephrectomy ◽

Operation Time ◽

Renal Tumors ◽

Open Partial Nephrectomy ◽

Estimated Blood Loss ◽

Significant Difference ◽

Operative Complications ◽

Group A ◽

Group B ◽

Post Operative Complications

Introduction: The aim of this study was to compare laparoscopic and open partial nephrectomy (PN) for renal tumors of high surgical complexity (PADUA score ⩾10). Methods: We retrospectively evaluated 93 consecutive patients who underwent PN at our department from January 2015 to September 2019. 21 patients underwent open partial nephrectomy (OPN) (Group A) and 72 underwent laparoscopic partial nephrectomy (LPN) (Group B). All OPNs were performed with a retroperitoneal approach, while all LPNs were performed with a transperitoneal approach by a single surgical team. Post-operative complications were classified according to the Clavien-Dindo system. Results: The two groups showed no difference in terms of patients’ demographics as well as tumor characteristics in all variables. Group A was found to be similar to group B in terms of operation time ( p = 0.781), conversion to radical nephrectomy ( p = 0.3485), and positive surgical margins ( p = 0.338) while estimated blood loss ( p = 0.0205), intra-operative ( p = 0.0104), and post-operative ( p = 0.0081) transfusion rates, drainage time ( p = 0.0012), pain score at post-operative day 1 (<0.0001) were significantly lower in Group B. The rate of enucleation and enucleoresection/polar resection was similar ( p = 0.1821) among the groups. Logistic regression analysis indicated that preoperative factors were not independently associated with the surgical approach. There was a statistically significant difference in complication rate (<0.0001) between the two groups even if no significant difference in terms of grade ⩾3 post-operative complications ( p = 0.3382) was detected. Discussion: LPN represents a feasible and safe approach for high complex renal tumors if performed in highly experienced laparoscopic centers. This procedure offers good intraoperative outcomes and a low rate of post-operative complications.

Download Full-text

Association between R.E.N.A.L nephrometry score and perioperative outcomes following open partial nephrectomy under cold ischemia

Canadian Urological Association Journal ◽

10.5489/cuaj.1372 ◽

2014 ◽

Vol 8 (3-4) ◽

pp. 137

Author(s):

Dong Soo Park ◽

Jin Ho Hwang ◽

Moon Hyung Kang ◽

Jong Jin Oh

Keyword(s):

Blood Loss ◽

Partial Nephrectomy ◽

Perioperative Outcomes ◽

Renal Neoplasm ◽

Cold Ischemia ◽

Ischemic Time ◽

Open Partial Nephrectomy ◽

Cold Ischemic Time ◽

Nephrometry Score ◽

Estimated Blood Loss

Introduction: We investigate the clinical significance of the R.E.N.A.L. nephrometry score for renal neoplasm following open partial nephrectomy (PN) under cold ischemia.Methods: A retrospective analysis was conducted using clinical data of 98 consecutive patients with clear cell renal cell carcinoma who underwent open PN by a single surgeon from December 2000 to September 2012. Tumour complexity was stratified into 3 categories: low (4-6), moderate (7-9) and high (10-12) complexity. Perioperative outcomes, such as complications, cold ischemic time, estimated blood loss and renal function, were analyzed according to the complexity by NS. Complications were stratified using the Clavien-Dindo classification system.Results: Tumour complexity according to nephrometry score was assessed as low in 16 (16.3%), moderate in 48 (49.0%) and high in 34 (34.7%). The median cold ischemic time did not differ significantly among the 3 groups (36.0 minutes in low-, 40 minutes in moderate- and 43 minutes in the high-complexity group, p = 0.421). Total complications did not differ significantly (2 (2.0%) in low, 4 (4.1%) in moderate and 4 (4.1%) in high, p = 0.984). Each Grade 3 complication occurred in the moderate (urine leakage) and high groups (lymphocele). Postoperative renal functional outcomes were similar among the groups (p = 0.729). Only mean estimated blood loss was significantly different with nephrometry score (p = 0.049).Conclusions: The nephrometry score, as used in an open PN series under cold ischemia, was not significantly associated with perioperative outcomes (i.e., ischemia time, complications, renal functional preservation).

Download Full-text

Early Single-Center Experience with Robotic Partial Nephrectomy Using the da Vinci Xi: Comparative Assessment with Conventional Open Partial Nephrectomy

Current Urology ◽

10.1159/000499300 ◽

2019 ◽

Vol 13 (1) ◽

pp. 13-18 ◽

Cited By ~ 1

Author(s):

Daisuke Motoyama ◽

Ryota Aki ◽

Yuto Matsushita ◽

Keita Tamura ◽

Toshiki Ito ◽

...

Keyword(s):

Partial Nephrectomy ◽

Da Vinci ◽

Operative Procedure ◽

Surgical Margin ◽

Perioperative Outcomes ◽

Robotic Partial Nephrectomy ◽

Da Vinci Xi ◽

Ischemic Time ◽

Open Partial Nephrectomy ◽

Estimated Blood Loss

Background: The objective of this study was to evaluate our experience with robot-assisted partial nephrectomy (RAPN) in comparison with conventional open partial nephrectomy (OPN). Patients and Methods: This study included 37 and 50 patients undergoing OPN and RAPN for small renal masses, respectively. A single surgeon performed RAPN for all 50 cases using the da Vinci Xi. Trifecta was defined as satisfying all of the following 3 criteria: ischemic time of ≤ 25 minutes, negative surgical margin and no major postoperative complications. Results: After adjusting patient variables by 1:1 propensity-score matching, 37 patients were included in each group, and no significant differences in major clinicopathological characteristics were noted between these 2 groups. RAPN was significantly superior to OPN with respect to operative time, estimated blood loss and postoperative length of hospital stay. The rate of trifecta achievement was significantly higher in the RAPN group than in the OPN group (91.9 vs. 62.2%). Furthermore, the operative procedure and R.E.N.A.L. nephrometry score were found to be independently associated with trifecta outcome by multivariate analysis of the entire cohort. Conclusions: Although this is our early experience with 50 initial cases, RAPN using the da Vinci Xi resulted in more favorable perioperative outcomes than OPN.

Download Full-text

The Self-Retaining Barbed Suture for Parenchymal Repair in Laparoscopic Partial Nephrectomy: A Systematic Review and Meta-Analysis

Surgical Innovation ◽

10.1177/1553350619856167 ◽

2019 ◽

Vol 26 (6) ◽

pp. 744-752

Author(s):

Hailun Zhan ◽

Chunping Huang ◽

Tengcheng Li ◽

Fei Yang ◽

Jiarong Cai ◽

...

Keyword(s):

Renal Function ◽

Blood Loss ◽

Hospital Stay ◽

Partial Nephrectomy ◽

Operative Time ◽

Meta Analysis ◽

Length Of Hospital Stay ◽

The Self ◽

Barbed Suture ◽

Estimated Blood Loss

Objectives. The warm ischemia time (WIT) is key to successful laparoscopic partial nephrectomy (LPN). The aim of this study was to perform a meta-analysis comparing the self-retaining barbed suture (SRBS) with a non-SRBS for parenchymal repair during LPN. Methods. A systematic search of PubMed, Scopus, and the Cochrane Library was performed up to March 2018. Inclusion criteria for this study were randomized controlled trials (RCTs) and observational comparative studies assessing the SRBS and non-SRBS for parenchymal repair during LPN. Outcomes of interest included WIT, complications, overall operative time, estimated blood loss, length of hospital stay, and change of renal function. Results. One RCT and 7 retrospective studies were identified, which included a total of 461 cases. Compared with the non-SRBS, use of the SRBS for parenchymal repair during LPN was associated with shorter WIT ( P < .00001), shorter overall operative time ( P < .00001), lower estimated blood loss ( P = .02), and better renal function preservation ( P = .001). There was no significant difference between the SRBS and non-SRBS with regard to complications ( P = .08) and length of hospital stay ( P = .25). Conclusions. The SRBS for parenchymal repair during LPN can significantly shorten the WIT and overall operative time, decrease blood loss, and preserve renal function.

Download Full-text