Complications and blood loss after invasive treatments for small renal masses A systematic review.

INTRODUCTION

This systematic review and meta-analysis provides estimates of major complications and estimated blood loss (EBL) for open partial nephrectomy (OPN), conventional laparoscopic partial nephrectomy (LPN), and robot-assisted partial nephrectomy (RAPN). Additionally, it outlines the incidence of major complications associated with percutaneous thermal ablation (TA) in patients with small renal masses (SRMs).

METHODS

We searched MEDLINE, EMBASE, and CINAHL from inception to the end of July 2023. We supplemented the electronic search with a hand search of the references in the included studies and suggestions from two content experts. We used random effect meta-analysis to obtain pooled estimates of major complications and EBL. We used the QUIPS tool for risk of bias assessment and applied a prognosis approach to rate the quality of evidence using the Grades of Recommendation, Assessment, Development, and Evaluation (GRADE) framework.

RESULTS

We included 65 eligible studies that provided pooled estimates of major complications after OPN of 5.4% (95% confidence interval [CI] 2.9-9.9); after conventional LPN of 4.7% (95% CI 2.6-8.3); after RAPN of 2.9% (95% CI 2.2-3.7); and after TA of 2.5% (95% CI 1.7-3.6). Pooled estimates demonstrating mean EBL of 262 ml (95% CI 200-324) for OPN; 224 ml (95% CI 193-254) for conventional LPN; and 163 ml (95% CI 136-190) for RAPN.

CONCLUSIONS

This review provides the best available estimates of major complications and mean EBL after partial nephrectomy in patients with SRMs.