Comparison of peri-operative outcomes of robot-assisted vs laparoscopic partial nephrectomy: a meta-analysis
A partir d'une revue de la littérature publiée jusqu'en janvier 2013 (7 études, 766 patients), cette méta-analyse évalue, à partir de données intra- et péri- opératoires, l'intérêt d'une néphrectomie partielle assistée par robot par rapport à une néphrectomie partielle laparoscopique chez les patients atteints d'un cancer du rein
Objective : To conduct a meta-analysis of the literature on the peri-operative outcomes of both robot-assisted partial nephrectomy (RAPN) and laparoscopic partial nephrectomy (LPN). Materials and Methods : An electronic database search of MEDLINE, EMBASE, Google Scholar and the Cochrane Library was performed for publications up to 8 January 2013. * All studies comparing RAPN with LPN were included. The outcome measures were demographic and peri-operative results, including operating time, warm ischaemia time, blood loss, length of hospital stay, conversion rates, positive surgical margins and complications. A meta-analysis of the results was conducted. Results : A total of 766 patients were included, 425 patients in the RAPN group and 341 patients in the LPN group. There was no significant difference between the two groups in any of the demographic variables (age: P = 0.89; sex: P = 0.31; malignant pathology: P = 0.54; tumour size: P = 0.99; tumour laterality: P = 0.06). There was no difference between the two groups regarding operating times (P = 0.75), estimated blood loss (P = 0.75), conversion rates (P = 0.52), positive surgical margins (P = 0.61), complications (P = 0.27) or length of hospital stay (P = 0.27), but the RAPN group had significantly shorter warm ischaemia times than the LPN group (P = 0.01; weighted mean difference: −3.65; 95% confidence interval, −6.46 to −0.83). Conclusion : This meta-analysis shows that RAPN provides equivalent peri-operative outcomes to those of LPN, with the added advantage of a significantly shorter warm ischaemia time.