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Minerva Urologica e Nefrologica 2019 April;71(2):113-20

DOI: 10.23736/S0393-2249.19.03391-5


language: English

Robot-assisted versus open partial nephrectomy: comparison of outcomes. A systematic review

Nikolaos GRIVAS 1, 2 , Nikolaos KALAMPOKIS 2, Alessandro LARCHER 3, 4, 5, Stavros TYRITZIS 6, 7, Koon H. RHA 8, Vincenzo FICARRA 9, Nicoló BUFFI 10, Achilles PLOUMIDIS 11, Riccardo AUTORINO 12, Francesco PORPIGLIA 13, Henk van der POEL 1, Alexandre MOTTRIE 3, 4, Geert de NAEYER 3, J-ERUS/YAU Robotic Urology Working Group 

1 Department of Urology, Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands; 2 Department of Urology, G. Hatzikosta General Hospital, Ioannina, Greece; 3 Department of Urology, OLV, Aalst, Belgium; 4 ORSI Academy, Melle, Belgium; 5 Division of Oncology, Unit of Urology, URI, San Raffaele IRCCS Hospital, Milan, Italy; 6 Section of Urology, Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden; 7 Center for Minimally Invasive Urological Surgery, Athens Medical Center, Athens, Greece; 8 Department of Urology and Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea; 9 Section of Urology, Gaetano Barresi Department of Human and Pediatric Pathology, University of Messina, Messina, Italy; 10 Humanitas Clinical and Research Center, Humanitas University, Milan, Italy; 11 Department of Urology, Athens Medical Center, Athens, Greece; 12 Division of Urology, McGuire VAMC and VCU Health Center, Richmond, VA, USA; 13 Department of Urology, San Luigi Gonzaga Hospital, Orbassano, Turin, Italy

INTRODUCTION: Robot-assisted partial nephrectomy (RAPN) is increasingly used for the surgical management of renal masses. Aim of this study was to analyze the available literature regarding the outcomes of RAPN compared to those of open partial nephrectomy (OPN).
EVIDENCE ACQUISITION: A literature search was performed up to October 2018 using PubMed, MEDLINE and Embase. Article selection followed the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) principles and Population, Intervention, Comparator, Outcomes (PICO) methodology was used. Population (P) was patients with renal masses who underwent RAPN (I). RAPN was compared with OPN (C). Outcomes of interest were perioperative, oncological and functional outcomes of both surgical procedures (O). Inclusion criteria were: randomized controlled studies andobservational cohort studies comparing RAPN versus OPN, which reported at least one outcome of interest.
EVIDENCE SYNTHESIS: Twenty-two manuscripts met our inclusion criteria and were included in the systematic review. RAPN was superior to OPN in terms of complication rate in 11 studies while similar results were observed in 9 studies. Positive surgical margins were similar in 13 studies while RAPN had lower surgical margins in 6 studies. Operative and warm ischemia times were longer in OPN in 13 and 10 studies, respectively. Seventeen and 19 studies showed that estimated blood loss and length of hospital stay were higher in RAPN. Estimated glomerular filtration rate decline and chronic kidney disease upstaging decline were similar in the majority of studies.
CONCLUSIONS: Current evidence demonstrate that RAPN is a reasonable alternative to OPN with regard to oncological and early functional outcomes with a straightforward advantage of improved perioperative morbidity, as expected by minimally invasive techniques. Nevertheless, there is still a great need for well-designed randomized studies with an extended follow-up.

KEY WORDS: Surgical procedures, operative; Nephrectomy; Carcinoma, renal cell; Robotics

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