Zhu Daqing, Shao Xue, Guo Gang, Zhang Nandong, Shi Taoping, Wang Yi, Gu Liangyou
Department of Urology, Hainan Hospital, Chinese PLA General Hospital, Sanya, China.
Department of Neurology, Hainan Hospital, Chinese PLA General Hospital, Sanya, China.
Front Oncol. 2021 Jan 8;10:592193. doi: 10.3389/fonc.2020.592193. eCollection 2020.
To compare perioperative, functional and oncological outcomes between transperitoneal robotic partial nephrectomy (TRPN) and retroperitoneal robotic partial nephrectomy (RRPN).
A literature searching of Pubmed, Embase, Cochrane Library and Web of Science was performed in August, 2020. Pooled odds ratios (ORs) or weighted mean differences (WMDs) with 95% confidence intervals (CIs) were estimated using fixed-effect or random-effect model. Publication bias was evaluated with funnel plots. Only comparative studies with matched design or similar baseline characteristics were included.
Eleven studies embracing 2,984 patients were included. There was no significant difference between the two groups regarding conversion to open (P = 0.44) or radical (P = 0.31) surgery, all complications (P = 0.06), major complications (P = 0.07), warm ischemia time (P = 0.73), positive surgical margin (P = 0.87), decline in eGFR (P = 0.42), CKD upstaging (P = 0.72), and total recurrence (P = 0.66). Patients undergoing TRPN had a significant higher minor complications (P = 0.04; OR: 1.39; 95% CI, 1.01-1.91), longer operative time (P < 0.001; WMD: 21.68; 95% CI, 11.61 to 31.76), more estimated blood loss (EBL, P = 0.002; WMD: 40.94; 95% CI, 14.87 to 67.01), longer length of hospital stay (LOS, P < 0.001; WMD: 0.86; 95% CI, 0.35 to 1.37). No obvious publication bias was identified.
RRPN is more favorable than TRPN in terms of less minor complications, shorter operative time, less EBL, and shorter LOS. Methodological limitations of the included studies should be considered while interpreting these results.
比较经腹腔机器人辅助部分肾切除术（TRPN）和经腹膜后机器人辅助部分肾切除术（RRPN）的围手术期、功能和肿瘤学结局。
2020年8月对PubMed、Embase、Cochrane图书馆和科学网进行文献检索。采用固定效应或随机效应模型估计合并比值比（OR）或加权平均差（WMD）及95%置信区间（CI）。用漏斗图评估发表偏倚。仅纳入匹配设计或基线特征相似的比较研究。
纳入11项研究，共2984例患者。两组在转为开放手术（P = 0.44）或根治性手术（P = 0.31）、所有并发症（P = 0.06）、主要并发症（P = 0.07）、热缺血时间（P = 0.73）、手术切缘阳性（P = 0.87）、估算肾小球滤过率（eGFR）下降（P = 0.42）、慢性肾脏病（CKD）分期升级（P = 0.72）和总复发率（P = 0.66）方面无显著差异。接受TRPN的患者有显著更高的轻微并发症发生率（P = 0.04；OR：1.39；95%CI，1.01 - 1.91）、更长的手术时间（P < 0.001；WMD：21.68；95%CI，11.61至31.76）、更多的估计失血量（EBL，P = 0.002；WMD：40.94；95%CI，14.87至67.01）、更长的住院时间（LOS，P < 0.001；WMD：0.86；95%CI，0.35至1.37）。未发现明显的发表偏倚。
RRPN在轻微并发症更少、手术时间更短、EBL更少和LOS更短方面比TRPN更具优势。在解释这些结果时应考虑纳入研究的方法学局限性。
