Robotic Partial Nephrectomy Mostly Superior to Other Surgeries

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Robotic PN was associated with significantly lower rates of complications, cancer recurrence, and mortality compared with open and laparoscopic PN.
Robotic PN was associated with significantly lower rates of complications, cancer recurrence, and mortality compared with open and laparoscopic PN.

Robotic partial nephrectomy (RPN) results in most superior outcomes than either open (OPN) or laparoscopic partial nephrectomy (LPN), according to a new systematic review and meta-analysis.

Compared with OPN, RPN was associated with significantly less blood loss; fewer transfusions, complications, and readmissions; and shorter hospital stay, a team led by Inderbir S. Gill, MD, of the University of Southern California Keck School of Medicine in Los Angeles, reported in the Journal of Urology (2018;200:258-274). Patients who underwent RPN also had less of a decline in estimated glomerular filtration rate (eGFR), lower recurrence rates, and improved survival. OPN, however, was associated with shorter operative and warm ischemia times than RPN.

Compared with LPN, RPN proved superior with shorter warm ischemia times, lower conversion rates, and fewer intraoperative and postoperative complications. Robotic surgery was also associated with fewer positive margins, less decline in eGFR, and better overall mortality. Results held even when investigators analyzed only complex renal mass cases.

The team further reported that hilar control techniques, selective and unclamped, are effective alternatives to clamped RPN.

The systematic review and meta-analysis focused on 98 comparative studies involving 20,282 patients.

“Based on the contemporary literature, our comprehensive meta-analysis indicates that robotic partial nephrectomy delivers mostly superior, and at a minimum equivalent, outcomes compared to open and laparoscopic partial nephrectomy,” Dr Gill's team concluded. “Robotics has now matured into an excellent approach for performing partial nephrectomy for small renal masses.”

Reference

Cacciamani GE, Medina LG, Gill T, et al. Impact of surgical factors on robotic partial nephrectomy outcomes: Comprehensive systematic review and meta-analysis. J Urol. 2018;200:258-274. DOI: 10.1016/j.juro.2017.12.086

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