Comparison of perioperative outcomes of robotic vs. laparoscopic partial nephrectomy for renal tumors with a RENAL nephrometry score ≥7: A meta-analysis.

Introduction: To compare the perioperative outcomes of robotic partial nephrectomy (RPN) vs. laparoscopic partial nephrectomy (LPN) for complex renal tumors with a RENAL nephrometry score ≥7.

Methods: We searched PubMed, EMBASE and the Cochrane Central Register for studies from 2000 to 2020 to evaluate the perioperative outcomes of RPN and LPN in patients with a RENAL nephrometry score ≥7. We used RevMan 5.2 to pool the data.

Results: Seven studies were acquired in our study. No significant differences were found in the estimated blood loss (WMD: 34.49; 95% CI: -75.16-144.14;  = 0.54), hospital stay (WMD: -0.59; 95% CI: -1.24-0.06;  = 0.07), positive surgical margin (OR: 0.85; 95% CI: 0.65-1.11;  = 0.23), major postoperative complications (OR: 0.90; 95% CI: 0.52-1.54;  = 0.69) and transfusion (OR: 0.72; 95% CI: 0.48-1.08;  = 0.11) between the groups. RPN showed better outcomes in the operating time (WMD: -22.45; 95% CI: -35.06 to -9.85;  = 0.0005), postoperative renal function (WMD: 3.32; 95% CI: 0.73-5.91;  = 0.01), warm ischemia time (WMD: -6.96; 95% CI: -7.30--6.62;  < 0.0001), conversion rate to radical nephrectomy (OR: 0.34; 95% CI: 0.17 to 0.66;  = 0.002) and intraoperative complications (OR: 0.52; 95% CI: 0.28-0.97;  = 0.04).

Discussion: RPN is a safe and effective alternative to LPNs for or the treatment of complex renal tumors with a RENAL nephrometry score ≥7 with a shorter warm ischemic time and better postoperative renal function.