Cacciamani GE, et al. - Literature-wide systematic review and cumulative meta-analysis were performed to critically evaluate the impact of surgical factors on the operative, peri-operative, functional, oncological and survival outcomes of robotic partial nephrectomy (RPN). To condense the sheer volume of analyses, for the first time, novel summary forest plots were used to present the data. Compared to open and laparoscopic PN, RPN delivered mostly superior, and at a minimum equivalent, outcomes. Researchers noted that for performing PN surgery for renal masses, robotics has now matured into an excellent approach.

Methods

• Researchers evaluated all English-language publications on RPN comparing various surgical approaches.
• The Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) statement and the Agency for Healthcare Research and Quality (AHRQ) guidelines were followed to evaluate Pubmed, Scopus and Web of Science databases (01/01/2000–10/31/2016, updated 06/2017).
• Continuous and dichotomous variables were compared via weighted mean difference (WMD) and odds ratio (OR), respectively.
• They performed sensitivity analyses as needed.

Results

• A total of 20,282 patients were included in this meta-analysis.
• On comparing with open PN, RPN was superior for blood loss (WMD:81.98; p < 0.00001), transfusions (OR:1.81; p < 0.001), complications (OR:1.87; p < 0.00001), hospital stay (WMD:2.26; p=0.001), readmissions (OR:2.58; p=0.005), latest eGFR % decrease (WMD: 0.37; p = 0.04), overall mortality (OR:4.45; p < 0.0001) and recurrence rate (OR:5.14; p < 0.00001).
• Similar outcomes were observed with sensitivity analyses adjusting for baseline disparities.
• Compared to laparoscopic PN, RPN was superior for ischemia time (WMD:4.07; p < 0.0001), conversion rate (OR:2.25; p=0.002), intraoperative (OR:2.07; p > 0.0001) and postoperative complications (OR:1.25; p=0.0003), positive margins (OR:1.73; p < 0.0001), latest eGFR % decrease (WMD:-1.97; p=0.02) and overall mortality (OR:2.98; p=0.04).
• Effective alternatives to clamped RPN included hilar control techniques, selective and unclamped.