Evaluation of robotic and laparoscopic partial nephrectomy for small renal tumours (T1a)
A partir d'une revue systématique de la littérature publiée entre 2000 et 2012 (6 études, 256 patients), cette méta-analyse compare, du point de vue de données péri-opératoires et du taux de complications, deux techniques de néphrectomie partielle, l'une réalisée par laparoscopie et l'autre assistée par robot, pour traiter des tumeurs rénales de stade T1a
Objective : To compare laparoscopic partial nephrectomy (LPN) with robotic PN (RPN) using meta-analytical techniques, since there has been a rise in the incidence of small renal masses (SRM; <4 cm) minimally invasive approaches are becoming more popular in dealing with such pathologies. Materials and Methods * A systematic review of the literature was performed to identify studies comparing LPN and RPN. * Comparative studies evaluating RPN and LPN that fulfilled the inclusion criteria were selected. * Data on preoperative, operative (operative time, estimated blood loss [EBL], and warm ischaemia time [WIT]), postoperative (length of stay [LOS]) variables and complications were collected. * A meta-analysis using random effect model was performed. * A further Bland–Altman analysis of some of the operative variables was done to compare their reproducibility and mean difference in techniques. Results * Six studies matched the selection criteria. In all, 256 patients were analysed (40% RPN and 60% LPN). * There was no significant different in EBL (P = 0.12, 95% confidence interval [CI] –12.01 to 104.26). * Similarly, there was no significant different in WIT between the groups (P = 0.23, 95% CI –15.22 to 3.70). * Also, LOS (P = 0.22, 95% CI –0.38 to 0.09) and overall postoperative complication rates were not significantly different between the groups (P = 0.84, 95% CI –0.05 to 0.06). Conclusions * Despite multiple studies reporting better perioperative variables for RPN, the present study found no significant differences between RPN and LPN. This has implications for both the surgeon and the patient. * Lack of randomised controlled trials in addition to a lack of long-term oncological data for RPN are current limitations.