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Meta-Analysis
. 2023 Feb 6;21(1):35.
doi: 10.1186/s12957-023-02916-y.

Oncologic and perioperative outcomes of laparoscopic versus open radical nephrectomy for the treatment of renal tumor (> 7 cm): a systematic review and pooled analysis of comparative outcomes

Li Wang #  1 , Kun-Peng Li #  2 , Shan Yin #  1 , Lin Yang #  1 , Ping-Yu Zhu  3
Affiliations
Meta-Analysis

Oncologic and perioperative outcomes of laparoscopic versus open radical nephrectomy for the treatment of renal tumor (> 7 cm): a systematic review and pooled analysis of comparative outcomes

Li Wang et al. World J Surg Oncol. .

Abstract

Objective: Systematic evaluation of the effectiveness and safety of laparoscopic radical nephrectomy (LRN) for renal tumor (>7 cm).

Methods: The databases PubMed, Scopus, SinoMed, ScienceDirect, and Google Scholar were systematically searched for trials up to November 2022. The pooled results were evaluated by weighted mean difference (WMD), odds ratio (OR), and hazard ratio (HR).

Results: This meta-analysis (18 trials) demonstrated that compared to open radical nephrectomy (ORN), LRN had a longer operative time (OT) (WMD=15.99, 95% CI: 6.74 to 25.24, p = 0.0007), lower estimated blood loss (EBL) (WMD = -237.07, 95% CI: -300.02 to -174.12, p < 0.00001), lower transfusion rates (OR = 0.37, 95% CI: 0.24 to 0.55, p < 0.00001), and shorter length of stay (LOS) (WMD = -2.95, 95% CI: -3.86 to -2.03, p < 0.00001). No statistically relevant differences were found in overall survival (OS) (HR = 1.04, 95% CI: 0.81 to 1.35, p = 0.76), cancer-specific survival (CSS) (HR = 1.28, 95% CI: 0.97 to 1.68, p = 0.08), progression-free survival (PFS) (HR = 1.20, 95% CI 0.97 to 1.48, p = 0.1), recurrence-free survival (RFS) (OR = 1.27, 95% CI: 0.89 to 1.81, p = 0.56), local recurrence rate (OR = 0.85, 95% CI: 0.42 to 1.71, p = 0.65), and intraoperative and postoperative complications.

Conclusion: For patients with renal tumors (> 7 cm), LRN has specific perioperative advantages over ORN (LOS, EBL, and transfusion rates). However, the OT was prolonged in the LRN group. In addition, no differences in complication or oncological outcomes (OS, CSS, PFS, RFS, and local recurrence rate) were reported.

Trial registration: PROSPERO CRD42022367114.

Keywords: Laparoscopic radical nephrectomy (LRN); Minimally invasive surgery; Oncological results; Open radical nephrectomy (ORN); Renal cell carcinoma (RCC).

PubMed Disclaimer

Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Flowchart of literature selection
Fig. 2
Fig. 2
Forest plot of oncological outcomes: A Overall survival (OS). B Cancer-specific survival (CSS). C Progression-free survival (PFS)
Fig. 3
Fig. 3
Forest plot of oncological outcomes: A Recurrence-free survival (RFS). B Local recurrence
Fig. 4
Fig. 4
Forest plot of perioperative outcomes: A Operative time (min). B Length of stay (day). C Estimated blood loss (ml)
Fig. 5
Fig. 5
Forest plot of perioperative outcomes: A Blood transfusion rate. B Intraoperative complications. C Postoperative complications
See this image and copyright information in PMC

References

    1. Sung H, Ferlay J, Siegel RL, Laversanne M, Soerjomataram I, Jemal A, et al. Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2021;71(3):209–249. doi: 10.3322/caac.21660. - DOI - PubMed
    1. Sun M, Thuret R, Abdollah F, Lughezzani G, Schmitges J, Tian Z, et al. Age-adjusted incidence, mortality, and survival rates of stage-specific renal cell carcinoma in North America: a trend analysis. Eur Urol. 2011;59(1):135–141. doi: 10.1016/j.eururo.2010.10.029. - DOI - PubMed
    1. Clayman RV, Kavoussi LR, Soper NJ, Dierks SM, Meretyk S, Darcy MD, et al. Laparoscopic nephrectomy: initial case report. J Urol. 1991;146(2):278–282. doi: 10.1016/s0022-5347(17)37770-4. - DOI - PubMed
    1. Hattori R, Osamu K, Yoshino Y, Tsuchiya F, Fujita T, Yamada S, et al. Laparoscopic radical nephrectomy for large renal-cell carcinomas. J Endourol. 2009;23(9):1523–1526. doi: 10.1089/end.2009.0393. - DOI - PubMed
    1. Jeon SH, Kwon TG, Rha KH, Sung GT, Lee W, Lim JS, et al. Comparison of laparoscopic versus open radical nephrectomy for large renal tumors: a retrospective analysis of multi-center results. BJU Int. 2011;107(5):817–821. doi: 10.1111/j.1464-410X.2010.09688.x. - DOI - PubMed

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