Kandi Maryam, Richard Patrick O, Violette Philippe D, Sreekanta Ashwini, Hanna Steven, Couban Rachel, Daza Julian, Leong Russell, Faisal Haseeb, Tamilselvan Divyalakshmi, Steen Jeremy, Tang Wang-Choi, Singh Jaswinder, Guyatt Gordon
Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada.
Division of Urology, Department of Surgery, Centre Hospitalier Universitaire de Sherbrooke, Centre de recherche du CHUS and University of Sherbrooke, QC, Canada.
Can Urol Assoc J. 2025 Apr;19(4):136-144. doi: 10.5489/cuaj.8970.
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).
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.
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.
This review provides the best available estimates of major complications and mean EBL after partial nephrectomy in patients with SRMs.
本系统评价和荟萃分析提供了开放性部分肾切除术（OPN）、传统腹腔镜部分肾切除术（LPN）和机器人辅助部分肾切除术（RAPN）的主要并发症及估计失血量（EBL）的评估。此外，还概述了小肾肿块（SRM）患者经皮热消融（TA）相关主要并发症的发生率。
我们检索了从创刊至2023年7月底的MEDLINE、EMBASE和CINAHL数据库。我们通过人工检索纳入研究中的参考文献以及两位内容专家的建议来补充电子检索。我们使用随机效应荟萃分析来获得主要并发症和EBL的汇总估计值。我们使用QUIPS工具进行偏倚风险评估，并采用预后方法根据推荐分级、评估、制定和评价（GRADE）框架对证据质量进行评级。
我们纳入了65项符合条件的研究，这些研究提供的汇总估计值显示，OPN后主要并发症的发生率为5.4%（95%置信区间[CI] 2.9 - 9.9）；传统LPN后为4.7%（95% CI 2.6 - 8.3）；RAPN后为2.9%（95% CI 2.2 - 3.7）；TA后为2.5%（95% CI 1.7 - 3.6）。汇总估计值显示，OPN的平均EBL为262毫升（95% CI 200 - 324）；传统LPN为224毫升（95% CI 193 - 254）；RAPN为163毫升（95% CI 136 - 190）。
本综述提供了SRM患者部分肾切除术后主要并发症和平均EBL的最佳可用评估。
