背景:机器人辅助的肾部分切除术(RAPN)可以通过经腹膜(TP)或腹膜后(RP)方法进行。然而,一种方法比另一种方法的优越性还没有确立。因此,本综述的主要目的是比较这两种手术入路的围手术期结局.
方法:系统检索文献以确定报告TPRAPN和RPRAPN后的围手术期结局的研究。研究方案在PROSPERO(CRD42023399496)注册。主要结果是比较两种方法的并发症发生率。
结果:本综述包括22项研究,5675名患者,RP组中的2524,TP组3151。RP组的总体并发症显著降低[赔率(OR)0.80(0.67,0.95),p=0.01]。然而,两组的主要并发症发生率相似.RP组手术时间明显缩短[平均差(MD)-16.7(-22.3,-11.0),p=<0.0001]。RP组的估计失血量(EBL)和输血需求(BT)显着降低。转行根治性肾切除术两组间无差异[OR0.66(0.33,1.33),p=0.25]或开放手术[OR0.68(0.24,1.92,p=0.47]和阳性手术切缘[OR0.93(0.66,1.31,p=0.69]]。RP组的住院时间(LOS)较短[MD-0.27(-0.45,-0.08),p=<0.00001]。
结论:RP方法,与TP相比,并发症发生率明显较低,EBL,需要BT和LOS。然而,由于缺乏关于该主题的随机研究,需要进一步的数据。
BACKGROUND: Robot-assisted partial nephrectomy (RAPN) can be performed either by a transperitoneal (TP) or a
retroperitoneal (RP) approach. However, the superiority of one approach over the other is not established. Hence, the primary aim of this
review was to compare perioperative outcomes between these two surgical approaches.
METHODS: Literature was systematically searched to identify studies reporting perioperative outcomes following TP RAPN and RP RAPN. The study protocol was registered with PROSPERO (CRD42023399496). The primary outcome was comparing complication rates between the two approaches.
RESULTS: This
review included 22 studies, 5675 patients, 2524 in the RP group, and 3151 in the TP group. The overall complications were significantly lower in the RP group [Odds ratio (OR) 0.80 (0.67, 0.95), p = 0.01]. However, the rate of major complications was similar between the two groups. The operative time was significantly shorter with the RP group [Mean Difference (MD)-16.7 (- 22.3, - 11.0), p = < 0.0001]. Estimated blood loss (EBL) and need for blood transfusion (BT) were significantly lower in the RP group. There was no difference between the two groups for conversion to radical nephrectomy [OR 0.66 (0.33, 1.33), p = 0.25] or open surgery [OR 0.68 (0.24, 1.92, p = 0.47] and positive surgical margins [OR 0.93 (0.66, 1.31, p = 0.69]. Length of stay (LOS) was shorter in the RP group [MD - 0.27 (- 0.45, - 0.08), p = < 0.00001].
CONCLUSIONS: RP approach, compared to TP, has significantly lower complication rates, EBL, need for BT and LOS. However, due to the lack of randomized studies on the topic, further data is required.