Comparison of transperitoneal and retroperitoneal laparoscopic nephrectomy for renal cell carcinoma: a systematic review and meta-analysis
Comparison of transperitoneal and retroperitoneal laparoscopic nephrectomy for renal cell carcinoma: a systematic review and meta-analysis
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经腹膜和后腹膜腹腔镜肾切除术治疗肾细胞癌的比较：系统评价和荟萃分析
DOI：
10.1111/j.1464-410x.2012.11598.x
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发表时间：
2013-04-01
影响因子：
4.5
通讯作者：
Huang, Jian
中科院分区：
文献类型：
--
作者：
Fan, Xinxiang;Xu, Kewei;Huang, Jian
目的评价后腹腔镜和经腹腔镜肾癌根治术（RN/PN）的有效性和安全性。方法系统检索PUBMED、EMBASE和科克伦图书馆，以确定比较两种手术方式疗效的前瞻性随机对照试验和回顾性观察性研究。结果12项研究评估了经腹膜腹腔镜RN（TLRN）与腹膜后腹腔镜RN（RLRN）的差异，6项研究评估了经腹膜腹腔镜PN（TLPN）与腹膜后腹腔镜PN（RLPN）的差异，RLRN入路的肾动脉控制时间较短（加权平均差[WMD] 68.65 min; 95%置信区间[CI] 40.80-96.50; P < 0.001）和总体并发症发生率（比值比2.12; 95% CI 1.30-3.47; P = 0.003）低于TLRN。RLPN手术时间短，（WMD 48.85 min; 95% CI 29.33-68.37; P < 0.001）和住院时间较短（WMD 1.01天; 95% CI 0.39-1.63; P = 0.001）。在其他相关结果方面，腹膜后和经腹膜途径之间无显著差异。分析表明，在适当选择的患者中，尤其是肾肿瘤位于后方的患者，腹膜后入路可能比经腹膜入路更快且同样安全，尽管我们采用了严格的方法，但由于纳入研究的固有局限性，从我们的汇总结果中得出的结论应谨慎解释。
ObjectiveTo evaluate the efficiency and safety of the retroperitoneal and transperitoneal approaches in laparoscopic radical/partial nephrectomy (RN/PN) for renal cell carcinoma.MethodsA systematic search of PUBMED, EMBASE, and the Cochrane Library was performed to identify prospective randomized controlled trials and retrospective observational studies that compared the outcomes of the two approaches.Outcomes of interest included perioperative and postoperative variables, surgical complications and oncological variables.ResultsTwelve studies assessing transperitoneal laparoscopic RN (TLRN) vs retroperitoneal laparoscopic RN (RLRN) and six studies assessing transperitoneal laparoscopic PN (TLPN) vs retroperitoneal laparoscopic PN (RLPN) were included.The RLRN approach had a shorter time to renal artery control (weighted mean difference [WMD] 68.65 min; 95% confidence interval [CI] 40.80-96.50; P < 0.001) and a lower overall complication rate (odds ratio 2.12; 95% CI 1.30-3.47; P = 0.003) than TLRN. RLPN had a shorter operating time (WMD 48.85 min; 95% CI 29.33-68.37; P < 0.001) and a shorter length of hospital stay (WMD 1.01 days; 95% CI 0.39-1.63; P = 0.001) than TLPN.There were no significant differences between the retroperitoneal and transperitoneal approaches in other outcomes of interest.ConclusionsThis meta-analysis indicates that, in appropriately selected patients, especially patients with posteriorly located renal tumours, the retroperitoneal approach may be faster and equally safe compared with the transperitoneal approach.Despite our rigorous methodology, conclusions drawn from our pooled results should be interpreted with caution because of the inherent limitations of the included studies.