Department of Urology, St. Vincent's University Hospital, Dublin 4, Ireland.
Royal College of Surgeons in Ireland, Dublin 2, Ireland.
BJU Int. 2023 Oct;132(4):353-364. doi: 10.1111/bju.16093. Epub 2023 Jun 15.
To perform a systematic review and network meta-analysis (NMA) to determine the advantages and disadvantages of open (OPN), laparoscopic (LPN), and robot-assisted partial nephrectomy (RAPN) with particular attention to intraoperative, immediate postoperative, as well as longer-term functional and oncological outcomes.
A systematic review was performed as per the Preferred Reporting Items for Systematic Reviews and Meta-Analyses-NMA guidelines. Binary data were compared using odds ratios (ORs). Mean differences (MDs) were used for continuous variables. ORs and MDs were extracted from the articles to compare the efficacy of the various surgical approaches. Statistical validity is guaranteed when the 95% credible interval does not include 1.
In total, there were 31 studies included in the NMA with a combined 7869 patients. Of these, 33.7% (2651/7869) underwent OPN, 20.8% (1636/7869) LPN, and 45.5% (3582/7689) RAPN. There was no difference for either LPN or RAPN as compared to OPN in ischaemia time, intraoperative complications, positive surgical margins, operative time or trifecta rate. The estimated blood loss (EBL), postoperative complications and length of stay were all significantly reduced in RAPN when compared with OPN. The outcomes of RAPN and LPN were largely similar except the significantly reduced EBL in RAPN.
This systematic review and NMA suggests that RAPN is the preferable operative approach for patients undergoing surgery for lower-staged RCC.
进行系统评价和网络荟萃分析（NMA），以确定开放式（OPN）、腹腔镜（LPN）和机器人辅助部分肾切除术（RAPN）的优缺点，特别关注术中、术后即刻以及更长期的功能和肿瘤学结果。
根据系统评价和荟萃分析-NMA 偏好报告项目的指南进行系统评价。使用优势比（OR）比较二项数据。使用均数差（MD）比较连续变量。从文章中提取 OR 和 MD 以比较各种手术方法的疗效。当 95%可信区间不包括 1 时，统计有效性得到保证。
共有 31 项研究纳入 NMA，共纳入 7869 例患者。其中，33.7%（2651/7869）接受 OPN，20.8%（1636/7869）接受 LPN，45.5%（3582/7689）接受 RAPN。与 OPN 相比，LPN 或 RAPN 的缺血时间、术中并发症、阳性切缘、手术时间或 trifecta 率均无差异。RAPN 与 OPN 相比，估计出血量（EBL）、术后并发症和住院时间均显著减少。RAPN 和 LPN 的结果基本相似，除了 RAPN 中 EBL 显著减少。
本系统评价和 NMA 表明，RAPN 是接受低分期 RCC 手术的患者更可取的手术方法。
