The present study aimed to conduct a pooled analysis to compare the efficacy and safety of minimally-invasive partial nephrectomy (MIPN) with open partial nephrectomy (OPN) in patients with complex renal tumors (defined as PADUA or RENAL score ≥7).
The present study followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement, Supplemental Digital Content 1, http://links.lww.com/JS9/A394. We conducted a systematic search of the PubMed, Embase, Web of Science, and Cochrane Library database until October 2022. MIPN and OPN-controlled trials for complex renal tumors were included. The primary outcomes were perioperative results, complications, renal function, and oncologic outcomes.
A total of 2405 patients were included in 13 studies. MIPN outperformed OPN in term of hospital stay (WMD -1.84 d, 95% CI -2.35, -1.33; P<0.00001), blood loss (WMD -52.42 mL, 95% CI -71.43, -33.41; P<0.00001), transfusion rates (OR 0.34, 95% CI 0.17, 0.67 P=0.002), major complications (OR 0.59, 95% CI 0.40, 0.86 P=0.007) and overall complications (OR 0.43, 95% CI 0.31, 0.59 P<0.0001), while operative time, warm ischemia time, conversion to radical nephrectomy rates, estimated glomerular (eGFR) decline, positive surgical margins (PSM), local recurrence, overall survival, recurrence-free survival, and cancer-specific survival were not significantly different.
The present study demonstrated that MIPN was associated with a shorter length of hospital stay, less blood loss and fewer complications in treating complex renal tumors. MIPN may be considered a better treatment for patients with complex tumors when technically feasible.
International journal of surgery (London, England). 2023 Apr 26 [Epub ahead of print]
Kun-Peng Li, Si-Yu Chen, Chen-Yang Wang, Li Yang
Department of Urology, The Second Hospital of Lanzhou University, Lanzhou, China.