Meta-analysis Of The Efficacy Of Robotic And Laparoscopic Treatment Of Complex Renal Tumors With Renal Nephrometry Score?7 For Partial Nephrectomy

Objective:Meta analysis was used to evaluate the clinical efficacy and safety of robot-assisted partial nephrectomy(RAPN)and laparoscopic partial nephrectomy(LPN)in the treatment of R.E.N.A.L.nephrometry score?7 complex renal tumors.Methods:Useing a computer to retrieve the common literature database comprehensively,including The Cochrane Library,PubMed,American Bioscience Abstracts Database(BIOSIS Previews),CBM,CNKI,Wanfang Database and Vip knowledge Resource Service platform and so on.The retrieval time is from the database building time to November 2018.Chinese search terms include: Da Vinci,robot,laparoscopic partial nephrectomy,laparoscopic nephron sparing surgery,complex renal tumor,complex renal cancer,R.E.N.A.L.Score,English retrieval with the following keywords:Da Vinci?robot*?laparoscopic partial nephrectomy?laparoscopic nephron sparing surgery?complex?RENAL nephrometry score.Two researchers independently selected the relevant literature and extracted relevant data in strict accordance with the inclusion and exclusion criteria of the literature.In the event of disagreement,ask the third researcher to help judge,if the agreement cannot be reached through mutual consultation.The quality of the literature was evaluated and the Meta analysis was carried out with RevMan5.3 software.The research indicators include:operation time,estimated blood loss,warm ischemia time,hospitalization time,blood transfusion rate,postoperative complications,intraoperative conversion rate(including intraoperative conversion to open operation or radical operation),positive rate of incisal margin and so on.Results:After rigorous screening,six retrospective cohort studies were included,including three Chinese and three English literatures.A total of 1028 patients with complex renal tumors(RENAL nephrometry score ?7)were included,of which 5175patients were undergoing robotic-assisted partial nephrectomy and 506 patients were undergoing general laparoscopic partial nephrectomy.The results of meta-analysis showed that there was no significant differences in age,sex,BMI,tumor size and RENAL score between the two surgical methods(P ? 0.05).RAPN and LPN for complex renal tumors with a RENAL nephrometry score ? 7,during operation time(MD=-26.01,95% CI:-36.61~-15.42,P<0.00001),estimated blood loss(MD=-24.24,95% CI:-39.54~-8.95,P<0.05),warm ischemia time(MD =-2.40,95% CI:-3.07~-1.73,P<0.00001),intraoperative conversion rate(including intraoperative conversion to open operation or radical operation)(OR=0.16,95% CI: 0.07~0.37,P<0.0001)was statistically significant,the results show that patients with RAPN have shorter operative time and warm ischemia time,less estimated blood loss and lower intraoperative transfer rate.There was no significant difference in hospitalization time(SMD=-0.12,95%CI:-0.24~-0.01,P>0.05),blood transfusion rate(OR=0.75,95%CI:0.47~1.18,P>0.05),postoperative complications(OR=0.83,95%CI:0.61~1.14,P>0.05)and positive rate of incisal margin(OR=0.44,95%CI:0.10~1.94,P>0.05)between the two different surgical methods to treat complex renal tumors.Conclusions:For patients with complex renal tumors(RENAL nephrometry score?7),although the two surgical methods are safe and effective on the whole,and there is no significant difference in hospitalization time,clinical blood transfusion rate,postoperative complications and positive rate of incision margin between them,but RAPN is more advantageous than LPN in terms of operation time,estimated blood loss,warm ischemia time and intraoperative transfer rate,and the use of RAPN may be more conducive to protect the renal function in patients.Therefore,in the center which is able to carry out Da Vinci robotic surgery,RAPN can be considered as the first choice for such patients,especially for the patients with complex renal tumors with absolute indication of nephrons paring surgery(NSS).However,due to the small number of literatures included in this study,all of which are retrospective cohort studies and lack of randomized controlled trials,some potential bias may be affect the results of the study.So it need more prospective,multicenter,high-quality and large-sample randomized controlled trials to validate the results.