Surgical Approach Does Not Impact Margin Status After Partial Nephrectomy for Large Renal Masses

Comparison of outcomes between laparoscopic and robot-assisted partial nephrectomy for complex renal tumors: RENAL score ≥7 or maximum tumor size >4 cm

INTRODUCTION

We reviewed current studies and performed a meta-analysis to compare outcomes between laparoscopic partial nephrectomy (LPN) and robot-assisted partial nephrectomy (RAPN) treating complex renal tumors (RENAL score ≥7 or maximum clinical tumor size >4 cm).

EVIDENCE ACQUISITION

Using the databases of PubMed, Embase, and the Cochrane Library, a comprehensive literature search was performed in April, 2020. Pooled odds ratios (ORs) or weighted mean differences (WMDs) with 95% confidence intervals (CIs) were calculated using fixed-effect or random-effect model. Publication bias was evaluated by funnel plots.

EVIDENCE SYNTHESIS

Ten observational studies including 5193 patients (LPN: 1574; RAPN: 3619) were included. There was no significant difference between the two groups regarding conversion to open (P=0.07) surgery, all complications (P=0.12), grade 1-2 complications (P=0.10), grade 3-5 complications (P=0.93), operative time (P=0.94), estimated blood loss (P=0.17). Patients undergoing LPN had a significant higher rate of conversion to radical (OR=4.33; 95% CI: 2.01-9.33; P<0.001), a longer ischemia time (IT, P<0.001; WMD=3.02 min; 95% CI: 1.67 to 4.36), a longer length of stay (LOS, P<0.001; WMD=0.67 days; 95% CI: 0.35 to 0.99), a lower rate of positive surgical margin (P=0.03; OR=0.71; 95% CI: 0.53 to 0.96), a greater eGFR decline (P<0.001; WMD=2.41 mL/min/1.73 m²; 95% CI: 1.22 to 3.60), a higher rate of CKD upstaging (P<0.001; OR=2.44; 95% CI: 1.54 to 3.87). No obvious publication bias was observed.

CONCLUSIONS

For complex renal tumors, RAPN is more favorable than LPN in terms of lower rate of conversion to radical surgery, shorter IT, shorter LOS, less eGFR decline, and lower rate of CKD upstaging. Methodological limitations of observational studies should be taken into account in interpreting these results.

Oncological and functional outcomes of open versus laparoscopic partial nephrectomy in T1b tumors: A single-center analysis

PURPOSE

This study aims to evaluate the oncological and functional results of open partial nephrectomy (OPN) and laparoscopic partial nephrectomy (LPN) at the T1b clinical stage, which constitutes 25% of renal cell carcinomas (RCC) at diagnosis.

MATERIALS AND METHODS

The characteristics of 63 patients with stage T1b solitary tumor who underwent OPN (41) or LPN (22) were compared. The survival analysis was performed using the Kaplan-Meier method. Univariate and multivariate Cox regression analyses were performed to determine the factors affecting disease-free survival. Potential predictive factors, which might affect the postoperative glomerular filtration rate (GFR), were evaluated using multivariate linear regression analysis.

RESULTS

No differences were observed between OPN and LPN groups regarding patient and tumor characteristics. Although the warm ischemia time, intraoperative estimated blood loss, and operation duration were higher in the LPN group, no differences were noted between the two techniques regarding complication rates (p<0.001, p=0.023, p≤0.001, and p=0.190, respectively). The median hospitalization time was shorter in the LPN group than that in the OPN group (4 and 5 days, respectively), with less severe complications. No intergroup differences were observed regarding cancer-specific survival (CSS), disease-free survival (DFS), and overall survival (OS). The evaluation of the factors affecting DFS showed that age was an effective parameter (RR = 1.112, 95% CI: 1.010-8.254), but the surgical technique was not.

CONCLUSION

No differences were observed between OPN and LPN techniques between oncological and functional outcomes in patients with clinical stage T1b RCC.