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 blood loss for open partial nephrectomy, conventional laparoscopic partial nephrectomy, and robot-assisted partial nephrectomy. Additionally, it outlines the incidence of major complications associated with percutaneous thermal ablation in patients with small renal masses.

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 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 blood loss. 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 open partial nephrectomy of 5.4% (95% confidence interval [CI] 2.9-9.9); after conventional laparoscopic partial nephrectomy of 4.7% (95% CI 2.6-8.3); after robot-assisted partial nephrectomy of 2.9% (95% CI 2.2-3.7); and after thermal ablation of 2.9% (95% CI 2.3-3.8). Pooled estimates demonstrating mean estimated blood loss of 262 ml (95% CI 200-324) for open partial nephrectomy; 224 ml (95% CI 193-254) for conventional laparoscopic partial nephrectomy; and 163 ml (95% CI 136-190) for robot-assisted partial nephrectomy.

Conclusions: This review provides the best available estimates of major complications and mean blood loss after partial nephrectomy in patients with small renal masses.