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机器人辅助与开放性部分肾切除术治疗肾恶性肿瘤的比较:以肿瘤学结局为重点的系统评价和文献荟萃分析

Comparison of Robot-Assisted Versus Open Partial Nephrectomy for Treating Renal Malignancies With An Emphasis on Oncological Outcomes: A Systematic Review and Meta-Analysis of The Literature.

作者信息

Kozyrakis Diomidis, Tzavara Chara, Damaskos Christos, Zarkadas Anastasios, Bozios Dimitrios, Karmogiannis Athanasios, Konstantinopoulos Vasileios, Haronis Georgios, Konomi Anna-Maria, Kallinikas Georgios, Safioleas Konstantinos, Filios Athanasios, Mytiliniou Despoina, Rodinos Evangelos, Filios Panagiotis, Dimitroulis Dimitrios

机构信息

Department of Urology, Konstantopouleio-Patision General Hospital of Nea Ionia, Nea Ionia, Athens, Greece.

Department of Biostatistics, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece.

出版信息

Curr Urol Rep. 2025 Jun 24;26(1):53. doi: 10.1007/s11934-025-01282-4.

Abstract

PURPOSE OF REVIEW

Robotic assisted partial nephrectomy (RaPN) is the treatment of choice for small and resectable renal tumors offering better results in terms of blood loss, postoperative complications and length of hospital stay compared with the open partial nephrectomy (OPN), while for both techniques the risk of postoperative renal dysfunction is limited. However, the oncologic outcomes of the robotic procedure are yet to be determined. Therefore, a comprehensive research of PubMed/Medline, Embase and Scopus databases from the year 2000 till June 2024 was performed to elucidate the results related to oncologic outcomes. The ROBINS-I tool for non-randomized cohort studies was applied for the assessment of the quality of the included studies. All statistical analyses were performed with the use of STATA software version 15.0.

RECENT FINDINGS

The study was registered in International Platform of Registered Systematic Review and Metaanalysis Protocols database with the registration number INPLASY202450054. Overall 11 studies with 4758 patients were included in the present systematic review and meta-analysis. No statistically significant difference between the two treatment methods was reconded for the outcomes of overall survival [HR: 1.23 (95% CI: 0.68, 2.20)- p = 0.488], disease-specific survival [OR: 2.53 (95% CI: 0.65, 9.78)- p = 0.179], progression-free survival [HR: 1.04 (95% CI: 0.60, 1.79)- p = 0.901], recurrence-free survival [HR: 0.83 (95% CI = 0.54, 1.27)-p = 0.394] and disease-free survival [OR: 1.01 (95% CI = 0.98, 1.03)-p = 0.582]. The quality of most of the included studies was deemed moderate. Despite the need for more high quality comparative studies it is assumed that these results could be helpful in decision making and in counselling patients with resectable renal tumors to whom a nephron sparing surgery may be considered.

摘要

综述目的

机器人辅助部分肾切除术(RaPN)是治疗小型可切除肾肿瘤的首选方法,与开放性部分肾切除术(OPN)相比,在失血、术后并发症和住院时间方面效果更好,而对于这两种技术,术后肾功能不全的风险都有限。然而,机器人手术的肿瘤学结果尚未确定。因此,对2000年至2024年6月的PubMed/Medline、Embase和Scopus数据库进行了全面检索,以阐明与肿瘤学结果相关的研究结果。采用非随机队列研究的ROBINS-I工具评估纳入研究的质量。所有统计分析均使用STATA软件15.0版进行。

最新发现

该研究已在国际注册系统评价和Meta分析方案平台数据库中注册,注册号为INPLASY202450054。本系统评价和Meta分析共纳入11项研究,涉及4758例患者。两种治疗方法在总生存期[风险比(HR):1.23(95%置信区间:0.68,2.20)-P=0.488]、疾病特异性生存期[比值比(OR):2.53(95%置信区间:0.65,9.78)-P=0.179]、无进展生存期[HR:1.04(95%置信区间:0.60,1.79)-P=0.901]、无复发生存期[HR:0.83(95%置信区间=0.54,1.27)-P=0.394]和无病生存期[OR:1.01(95%置信区间=0.98,1.)方面无统计学显著差异。大多数纳入研究的质量被认为中等。尽管需要更多高质量的比较研究,但可以认为这些结果有助于决策,并为考虑保留肾单位手术的可切除肾肿瘤患者提供咨询。

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