Robot-assisted versus laparoscopic partial nephrectomy for localized renal tumors: a meta-analysis.
Robot-assisted versus laparoscopic partial nephrectomy for localized renal tumors: a meta-analysis.
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机器人辅助与腹腔镜肾部分切除术治疗局限性肾肿瘤：一项荟萃分析。
DOI：
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复制
发表时间：
2014
影响因子：
0.1
通讯作者：
Shouhua Pan
中科院分区：
文献类型：
--
作者：
Xiao;Jia;Yu Ren;C. Shen;X. Ying;Shouhua Pan
背景
机器人辅助肾部分切除术（RAPN）越来越频繁地用于局部肾肿瘤的微创治疗。然而，目前还不清楚RAPN是否比标准的腹腔镜肾部分切除术（LPN）更有效。本荟萃分析的目的是比较RAPN和LPN治疗局限性肾肿瘤的围手术期和肿瘤学结局。
方法
系统检索MEDLINE、EMBASE和奥维德等电子数据库。比较RAPN和LPN治疗局限性肾肿瘤的比较研究被视为合格。计算每个结局的平均差（MD）、比值比（OR）及其相应的95%置信区间（CI）。纳入研究的方法学质量采用严格的Newcastle-Ottawa量表标准进行评价。
结果
本荟萃分析纳入了14项比较研究（n = 1539例受试者）。RAPN和LPN的手术时间相似（MD = 6.33，95% CI [-23.93，36.59]），然而，热缺血时间有利于RAPN（MD =-3.29，95% CI [-6.47，-0.10]）。估计失血量（EBL）（MD =-42.24，95%CI [-87.10，2.61]）和住院时间（LOS）（MD =-0.29，95%CI [-0.89，0.32]）无显著差异。RAPN和LPN的术中并发症发生率相似（OR = 0.68，95% CI [0.29，1.58]），以及术后轻微并发症的发生率（OR = 1.10，95% CI [0.80，1.51]）和Clavien分类的术后主要并发症分布（OR = 0.99，95% CI [0.61，1.61]）。此外，在手术切缘阳性率方面没有发现显著差异（OR = 1.12，95% CI [0.56，2.25]）。
结论
RAPN的手术时间、LOS、EBL和围手术期并发症以及切缘阳性率与LPN相似。与LPN相比，RAPN似乎具有降低WIT的优势。需要进行长期随访研究，以比较RAPN和LPN的长期并发症和肿瘤结局。
BACKGROUND
Robot-assisted partial nephrectomy (RAPN) is being performed more frequently for the minimally invasive management of localized renal tumors. However, it's unclear whether RAPN is more efficacious than the standard laparoscopic partial nephrectomy (LPN). The objective of this meta-analysis is to compare RAPN and LPN in terms of perioperative and oncologic outcomes for the treatment of localized renal tumors.
METHODS
A systematic search of electronic databases including MEDLINE, EMBASE and OVID was conducted. Comparative studies comparing RAPN and LPN for the treatment of localized renal tumors were regarded eligible. The mean difference (MD), odds ratio (OR) and their corresponding 95% confidence intervals (CI) were calculated for each outcome. The methodologic quality of the included studies was evaluated using the strict criteria of the Newcastle-Ottawa scale.
RESULTS
14 comparative studies (n = 1539 participants) were included in the present meta-analysis. Operative time was similar for RAPN and LPN (MD = 6.33, 95% CI [-23.93, 36.59]), however, warm ischemia time favored RAPN (MD = -3.29, 95% CI [-6.47, -0.10]). There was no significant difference in estimated blood loss (EBL) (MD = -42.24, 95% CI [-87.10, 2.61]) and length of stay (LOS) (MD = -0.29, 95% CI [-0.89, 0.32]). The incidence of intraoperative complications was similar for RAPN and LPN (OR = 0.68, 95% CI [0.29, 1.58]), as well as incidence of postoperative minor complications (OR = 1.10, 95% CI [0.80, 1.51]) and postoperative major complications distributions by Clavien classification (OR = 0.99, 95% CI [0.61, 1.61]). In addition, no significant difference was found in terms of positive surgical margin rate (OR = 1.12, 95% CI [0.56, 2.25]).
CONCLUSIONS
RAPN had similar operative time, LOS, EBL, and perioperative complications compared with LPN, as well as positive margin rates. RAPN appears to offer the advantage of decreased WIT compared with LPN. Studies with long-term follow up are needed to compare RAPN and LPN in terms of long-term complications and oncologic outcomes.
DOI：
10.1016/j.juro.2008.09.017
发表时间：
2009-01
期刊：
The Journal of urology
影响因子：
--
作者：
Huang WC;Elkin EB;Levey AS;Jang TL;Russo P
通讯作者：
Russo P
影响因子：
2.1
作者：
Pierorazio PM;Patel HD;Feng T;Yohannan J;Hyams ES;Allaf ME
通讯作者：
Allaf ME