RENAL肾计量评分≥7的肾肿瘤患者行机器人辅助与腹腔镜下肾部分切除术围手术期结局的比较：一项荟萃分析。

Comparison of perioperative outcomes of robotic vs. laparoscopic partial nephrectomy for renal tumors with a RENAL nephrometry score ≥7: A meta-analysis.

作者信息

Jiang Yu-Li, Yu Dong-Dong, Xu Yang, Zhang Ming-Hua, Peng Fu-Sheng, Li Peng

机构信息

Department of Urology, Hu Zhou Central Hospital, Huzhou, China.

出版信息

Front Surg. 2023 Mar 15;10:1138974. doi: 10.3389/fsurg.2023.1138974. eCollection 2023.

INTRODUCTION

To compare the perioperative outcomes of robotic partial nephrectomy (RPN) vs. laparoscopic partial nephrectomy (LPN) for complex renal tumors with a RENAL nephrometry score ≥7.

METHODS

We searched PubMed, EMBASE and the Cochrane Central Register for studies from 2000 to 2020 to evaluate the perioperative outcomes of RPN and LPN in patients with a RENAL nephrometry score ≥7. We used RevMan 5.2 to pool the data.

RESULTS

Seven studies were acquired in our study. No significant differences were found in the estimated blood loss (WMD: 34.49; 95% CI: -75.16-144.14; = 0.54), hospital stay (WMD: -0.59; 95% CI: -1.24-0.06; = 0.07), positive surgical margin (OR: 0.85; 95% CI: 0.65-1.11; = 0.23), major postoperative complications (OR: 0.90; 95% CI: 0.52-1.54; = 0.69) and transfusion (OR: 0.72; 95% CI: 0.48-1.08; = 0.11) between the groups. RPN showed better outcomes in the operating time (WMD: -22.45; 95% CI: -35.06 to -9.85; = 0.0005), postoperative renal function (WMD: 3.32; 95% CI: 0.73-5.91; = 0.01), warm ischemia time (WMD: -6.96; 95% CI: -7.30--6.62; < 0.0001), conversion rate to radical nephrectomy (OR: 0.34; 95% CI: 0.17 to 0.66; = 0.002) and intraoperative complications (OR: 0.52; 95% CI: 0.28-0.97; = 0.04).

DISCUSSION

RPN is a safe and effective alternative to LPNs for or the treatment of complex renal tumors with a RENAL nephrometry score ≥7 with a shorter warm ischemic time and better postoperative renal function.

引言

比较机器人辅助肾部分切除术（RPN）与腹腔镜肾部分切除术（LPN）治疗RENAL肾计量评分≥7的复杂肾肿瘤的围手术期结局。

方法

我们检索了PubMed、EMBASE和Cochrane中央对照试验注册库，以获取2000年至2020年期间评估RENAL肾计量评分≥7的患者行RPN和LPN的围手术期结局的研究。我们使用RevMan 5.2对数据进行汇总。

结果

我们的研究纳入了7项研究。两组在估计失血量（加权均数差：34.49；95%可信区间：-75.16至144.14；P = 0.54）、住院时间（加权均数差：-0.59；95%可信区间：-1.24至0.06；P = 0.07）、手术切缘阳性率（比值比：0.85；95%可信区间：0.65至1.11；P = 0.23）、术后主要并发症（比值比：0.90；95%可信区间：0.52至1.54；P = 0.69）和输血率（比值比：0.72；95%可信区间：0.48至1.08；P = 0.11）方面未发现显著差异。RPN在手术时间（加权均数差：-22.45；95%可信区间：-35.06至-9.85；P = 0.0005）、术后肾功能（加权均数差：3.32；95%可信区间：0.73至5.91；P = 0.01）、热缺血时间（加权均数差：-6.96；95%可信区间：-7.30至-6.62；P < （此处原文有误，应为P < 0.0001））、根治性肾切除术转化率（比值比：0.34；95%可信区间：0.17至0.66；P = 0.002）和术中并发症（比值比：0.52；95%可信区间：0.28至0.97；P = 0.04）方面显示出更好的结局。