Trans-peritoneal vs. retroperitoneal robotic assisted partial nephrectomy in posterior renal tumours: need for a risk-stratified patient individualised approach. A systematic review and meta-analysis
To systematically review world literature and compare peri-operative outcome including operating time (OT), estimated blood loss (EBL), warm ischemia time (WIT), length of stay (LOS) and complications between retroperitoneal robotic assisted partial nephrectomy (RP-RAPN) and trans-peritoneal robotic...
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| Veröffentlicht in: | Journal of robotic surgery 2020-02, Vol.14 (1), p.1-9 |
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| creator | McLean, Andrew Mukherjee, Ankur Phukan, Chandan Veeratterapillay, Rajan Soomro, Naeem Somani, Bhaskar Rai, Bhavan Prasad |
| description | To systematically review world literature and compare peri-operative outcome including operating time (OT), estimated blood loss (EBL), warm ischemia time (WIT), length of stay (LOS) and complications between retroperitoneal robotic assisted partial nephrectomy (RP-RAPN) and trans-peritoneal robotic assisted partial nephrectomy (TP-RAPN) for posteriorly located renal masses. All randomised trials and observational studies comparing RP-RAPN and TP-RAPN for posteriorly located renal masses were considered. The GRADE approach (Grading of Recommendations Assessment, Development and Evaluation, GRADE) was used to rate the quality of evidence. 82 potential publications were identified. 3 were included in the review. All three studies were observational comparative studies. 347 and 550 patients underwent RP-RAPN and TP-RAPN, respectively, for posteriorly located tumours. There was statistically significant difference in LOS between the 2 techniques, favouring the RP-RAPN cohort: risk ratio (M-H, random, 95% CI), − 0.42 [− 0.67, − 0.18],
p
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| doi_str_mv | 10.1007/s11701-019-00973-8 |
| format | Article |
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p
< 0.0006. There was no statistically significant difference in overall complication rates between the two techniques: risk ratio (M-H, fixed, 95% CI), 0.80 [0.49, 1.30],
p
= 0.37. There was no statistically significant difference in ≥ Clavien 3a complication rates between the two t echniques: risk ratio (M-H, fixed, 95% CI), 1.17 [0.62, 2.19],
p
= 0.63. OT, EBL, WIT and positive margin rates were similar for both approaches. The quality of evidence for complications, LOS and remaining outcomes were ‘moderate’, ‘low’ and ‘very low’, respectively, on GRADE approach. The current review suggests that the LOS with RP-RAPN are significantly lesser than TP-RAPN for posterior tumours. The RP-RAPN does not appear to offer any advantage over TP-RAPN for other peri-operative outcomes such as WIT, OT and EBL. The surgical margin rates and morbidity between the two approaches appear to be similar.</description><identifier>ISSN: 1863-2483</identifier><identifier>EISSN: 1863-2491</identifier><identifier>DOI: 10.1007/s11701-019-00973-8</identifier><identifier>PMID: 31089965</identifier><language>eng</language><publisher>London: Springer London</publisher><subject>Comparative studies ; Ischemia ; Length of stay ; Literature reviews ; Medicine ; Medicine & Public Health ; Meta-analysis ; Minimally Invasive Surgery ; Patients ; Quality ; Review Article ; Risk ; Robotics ; Surgery ; Systematic review ; Tumors ; Urology</subject><ispartof>Journal of robotic surgery, 2020-02, Vol.14 (1), p.1-9</ispartof><rights>Springer-Verlag London Ltd., part of Springer Nature 2019</rights><rights>Springer-Verlag London Ltd., part of Springer Nature 2019.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c423t-f8dc5635145d2bb91037525f0690ce7cba71a6b69611a18eda0fdd74e7adcf4f3</citedby><cites>FETCH-LOGICAL-c423t-f8dc5635145d2bb91037525f0690ce7cba71a6b69611a18eda0fdd74e7adcf4f3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1007/s11701-019-00973-8$$EPDF$$P50$$Gspringer$$H</linktopdf><linktohtml>$$Uhttps://www.proquest.com/docview/2918716116?pq-origsite=primo$$EHTML$$P50$$Gproquest$$H</linktohtml><link.rule.ids>314,780,784,21388,21389,27924,27925,33530,33531,33744,33745,41488,42557,43659,43805,51319,64385,64387,64389,72469</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/31089965$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>McLean, Andrew</creatorcontrib><creatorcontrib>Mukherjee, Ankur</creatorcontrib><creatorcontrib>Phukan, Chandan</creatorcontrib><creatorcontrib>Veeratterapillay, Rajan</creatorcontrib><creatorcontrib>Soomro, Naeem</creatorcontrib><creatorcontrib>Somani, Bhaskar</creatorcontrib><creatorcontrib>Rai, Bhavan Prasad</creatorcontrib><title>Trans-peritoneal vs. retroperitoneal robotic assisted partial nephrectomy in posterior renal tumours: need for a risk-stratified patient individualised approach. A systematic review and meta-analysis</title><title>Journal of robotic surgery</title><addtitle>J Robotic Surg</addtitle><addtitle>J Robot Surg</addtitle><description>To systematically review world literature and compare peri-operative outcome including operating time (OT), estimated blood loss (EBL), warm ischemia time (WIT), length of stay (LOS) and complications between retroperitoneal robotic assisted partial nephrectomy (RP-RAPN) and trans-peritoneal robotic assisted partial nephrectomy (TP-RAPN) for posteriorly located renal masses. All randomised trials and observational studies comparing RP-RAPN and TP-RAPN for posteriorly located renal masses were considered. The GRADE approach (Grading of Recommendations Assessment, Development and Evaluation, GRADE) was used to rate the quality of evidence. 82 potential publications were identified. 3 were included in the review. All three studies were observational comparative studies. 347 and 550 patients underwent RP-RAPN and TP-RAPN, respectively, for posteriorly located tumours. There was statistically significant difference in LOS between the 2 techniques, favouring the RP-RAPN cohort: risk ratio (M-H, random, 95% CI), − 0.42 [− 0.67, − 0.18],
p
< 0.0006. There was no statistically significant difference in overall complication rates between the two techniques: risk ratio (M-H, fixed, 95% CI), 0.80 [0.49, 1.30],
p
= 0.37. There was no statistically significant difference in ≥ Clavien 3a complication rates between the two t echniques: risk ratio (M-H, fixed, 95% CI), 1.17 [0.62, 2.19],
p
= 0.63. OT, EBL, WIT and positive margin rates were similar for both approaches. The quality of evidence for complications, LOS and remaining outcomes were ‘moderate’, ‘low’ and ‘very low’, respectively, on GRADE approach. The current review suggests that the LOS with RP-RAPN are significantly lesser than TP-RAPN for posterior tumours. The RP-RAPN does not appear to offer any advantage over TP-RAPN for other peri-operative outcomes such as WIT, OT and EBL. The surgical margin rates and morbidity between the two approaches appear to be similar.</description><subject>Comparative studies</subject><subject>Ischemia</subject><subject>Length of stay</subject><subject>Literature reviews</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Meta-analysis</subject><subject>Minimally Invasive Surgery</subject><subject>Patients</subject><subject>Quality</subject><subject>Review Article</subject><subject>Risk</subject><subject>Robotics</subject><subject>Surgery</subject><subject>Systematic review</subject><subject>Tumors</subject><subject>Urology</subject><issn>1863-2483</issn><issn>1863-2491</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2020</creationdate><recordtype>article</recordtype><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><sourceid>DWQXO</sourceid><recordid>eNp9kUFv1DAQhSMEoqXwBzggS1y4eLHjOI65VRUtSJW4lHM0sR3qsomDx9lqfyF_i2m3FMSBU6J537x58quq11JspBDmPUpphORCWi6ENYp3T6pj2bWK142VTx__O3VUvUC8EUIbreTz6khJ0Vnb6uPq51WGGfkScixpDrBlO9ywHEpOf81yGlKJjgFixBI8WyCXSMIcluscXEnTnsWZLYnUHFMmh5nksk5pzfiBOFoaaQ4sR_zOsWQocYz3ViWGudC6j7voV9hGpDEsS07grjfslOGebCe4S5DDLoZbBrNnUyjAgc7sKdTL6tkIWwyvHr4n1dfzj1dnn_jll4vPZ6eX3DW1KnzsvNOt0rLRvh4GK4UyutajaK1wwbgBjIR2aG0rJcgueBCj96YJBrwbm1GdVO8OvpTuxxqw9FNEF7ZbmENasa9rVQuptVWEvv0HvaHHoLxEWdkZSTdaouoD5XJCzGHslxwnyPteiv6u5v5Qc0819_c19x0tvXmwXocp-MeV370SoA4AkjR_C_nP7f_Y_gI6wbkP</recordid><startdate>20200201</startdate><enddate>20200201</enddate><creator>McLean, Andrew</creator><creator>Mukherjee, Ankur</creator><creator>Phukan, Chandan</creator><creator>Veeratterapillay, Rajan</creator><creator>Soomro, Naeem</creator><creator>Somani, Bhaskar</creator><creator>Rai, Bhavan Prasad</creator><general>Springer London</general><general>Springer Nature B.V</general><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7X7</scope><scope>7XB</scope><scope>8FE</scope><scope>8FG</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABJCF</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>BENPR</scope><scope>BGLVJ</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>HCIFZ</scope><scope>K9.</scope><scope>L6V</scope><scope>M0S</scope><scope>M7S</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PTHSS</scope><scope>7X8</scope></search><sort><creationdate>20200201</creationdate><title>Trans-peritoneal vs. retroperitoneal robotic assisted partial nephrectomy in posterior renal tumours: need for a risk-stratified patient individualised approach. A systematic review and meta-analysis</title><author>McLean, Andrew ; Mukherjee, Ankur ; Phukan, Chandan ; Veeratterapillay, Rajan ; Soomro, Naeem ; Somani, Bhaskar ; Rai, Bhavan Prasad</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c423t-f8dc5635145d2bb91037525f0690ce7cba71a6b69611a18eda0fdd74e7adcf4f3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2020</creationdate><topic>Comparative studies</topic><topic>Ischemia</topic><topic>Length of stay</topic><topic>Literature reviews</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Meta-analysis</topic><topic>Minimally Invasive Surgery</topic><topic>Patients</topic><topic>Quality</topic><topic>Review Article</topic><topic>Risk</topic><topic>Robotics</topic><topic>Surgery</topic><topic>Systematic review</topic><topic>Tumors</topic><topic>Urology</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>McLean, Andrew</creatorcontrib><creatorcontrib>Mukherjee, Ankur</creatorcontrib><creatorcontrib>Phukan, Chandan</creatorcontrib><creatorcontrib>Veeratterapillay, Rajan</creatorcontrib><creatorcontrib>Soomro, Naeem</creatorcontrib><creatorcontrib>Somani, Bhaskar</creatorcontrib><creatorcontrib>Rai, Bhavan Prasad</creatorcontrib><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>ProQuest SciTech Collection</collection><collection>ProQuest Technology Collection</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>Materials Science & Engineering Collection</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central</collection><collection>Technology Collection</collection><collection>ProQuest One Community College</collection><collection>ProQuest Central Korea</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>SciTech Premium Collection</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>ProQuest Engineering Collection</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Engineering Database</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>Engineering Collection</collection><collection>MEDLINE - Academic</collection><jtitle>Journal of robotic surgery</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>McLean, Andrew</au><au>Mukherjee, Ankur</au><au>Phukan, Chandan</au><au>Veeratterapillay, Rajan</au><au>Soomro, Naeem</au><au>Somani, Bhaskar</au><au>Rai, Bhavan Prasad</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Trans-peritoneal vs. retroperitoneal robotic assisted partial nephrectomy in posterior renal tumours: need for a risk-stratified patient individualised approach. A systematic review and meta-analysis</atitle><jtitle>Journal of robotic surgery</jtitle><stitle>J Robotic Surg</stitle><addtitle>J Robot Surg</addtitle><date>2020-02-01</date><risdate>2020</risdate><volume>14</volume><issue>1</issue><spage>1</spage><epage>9</epage><pages>1-9</pages><issn>1863-2483</issn><eissn>1863-2491</eissn><abstract>To systematically review world literature and compare peri-operative outcome including operating time (OT), estimated blood loss (EBL), warm ischemia time (WIT), length of stay (LOS) and complications between retroperitoneal robotic assisted partial nephrectomy (RP-RAPN) and trans-peritoneal robotic assisted partial nephrectomy (TP-RAPN) for posteriorly located renal masses. All randomised trials and observational studies comparing RP-RAPN and TP-RAPN for posteriorly located renal masses were considered. The GRADE approach (Grading of Recommendations Assessment, Development and Evaluation, GRADE) was used to rate the quality of evidence. 82 potential publications were identified. 3 were included in the review. All three studies were observational comparative studies. 347 and 550 patients underwent RP-RAPN and TP-RAPN, respectively, for posteriorly located tumours. There was statistically significant difference in LOS between the 2 techniques, favouring the RP-RAPN cohort: risk ratio (M-H, random, 95% CI), − 0.42 [− 0.67, − 0.18],
p
< 0.0006. There was no statistically significant difference in overall complication rates between the two techniques: risk ratio (M-H, fixed, 95% CI), 0.80 [0.49, 1.30],
p
= 0.37. There was no statistically significant difference in ≥ Clavien 3a complication rates between the two t echniques: risk ratio (M-H, fixed, 95% CI), 1.17 [0.62, 2.19],
p
= 0.63. OT, EBL, WIT and positive margin rates were similar for both approaches. The quality of evidence for complications, LOS and remaining outcomes were ‘moderate’, ‘low’ and ‘very low’, respectively, on GRADE approach. The current review suggests that the LOS with RP-RAPN are significantly lesser than TP-RAPN for posterior tumours. The RP-RAPN does not appear to offer any advantage over TP-RAPN for other peri-operative outcomes such as WIT, OT and EBL. The surgical margin rates and morbidity between the two approaches appear to be similar.</abstract><cop>London</cop><pub>Springer London</pub><pmid>31089965</pmid><doi>10.1007/s11701-019-00973-8</doi><tpages>9</tpages></addata></record> |
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| subjects | Comparative studies Ischemia Length of stay Literature reviews Medicine Medicine & Public Health Meta-analysis Minimally Invasive Surgery Patients Quality Review Article Risk Robotics Surgery Systematic review Tumors Urology |
| title | Trans-peritoneal vs. retroperitoneal robotic assisted partial nephrectomy in posterior renal tumours: need for a risk-stratified patient individualised approach. A systematic review and meta-analysis |
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