Comparison of transperitoneal and retroperitoneal laparoscopic nephrectomy for renal cell carcinoma: a systematic review and meta‐analysis. (29th October 2012)

• Record Type: Journal Article
• Authors: Fan, Xinxiang; Xu, Kewei; Lin, Tianxin; Liu, Hao; Yin, Zi; Dong, Wen; Huang, Hai; Huang, Jian
• Is Part Of: BJU international. Volume 111:Number 4(2013:Feb.)
• Page Start: 611
• Page End: 621
• Publication Date: 2012-10-29
• Subjects: Genitourinary organs -- Diseases -- Periodicals; Genitourinary organs -- Surgery -- Periodicals; Urology -- Periodicals; 616.6
• DOI: 10.1111/j.1464-410X.2012.11598.x
• Languages: English
• ISSNs: 1464-4096

Abstract

<abstract abstract-type="main"> <title> <x xml:space="preserve">Abstract</x> </title> <sec id="bju11598-sec-1001" sec-type="section"> <title>What's known on the subject? and What does the study add?</title> <p> <list id="bju11598-list-0001" list-type="bullet"> <list-item> <p>Laparoscopic nephrectomy is now considered to be the reference procedure for kidney cancer. It can be performed via a transperitoneal or retroperitoneal approach. Each approach has its advantages and disadvantages. No definitive conclusions regarding objective difference between the two approaches have been reached to date.</p> </list-item> <list-item> <p>This meta‐analysis indicates that in appropriately selected patients, especially patients with posteriorly located renal tumors, the retroperitoneal approach may be faster and equally safe compared with the transperitoneal approach.</p> </list-item> </list> </p> </sec> <sec id="bju11598-sec-1002" sec-type="section"> <title>Objective</title> <p> <list id="bju11598-list-0002" list-type="bullet"> <list-item> <p>To evaluate the efficiency and safety of the retroperitoneal and transperitoneal approaches in laparoscopic radical/partial nephrectomy (RN/PN) for renal cell carcinoma.</p> </list-item> </list> </p> </sec> <sec id="bju11598-sec-1003" sec-type="section"> <title>Methods</title> <p> <list id="bju11598-list-0003" list-type="bullet"> <list-item> <p>A systematic search of PUBMED, EMBASE, and the Cochrane Library was performed to identify prospective randomized controlled trials and retrospective observational studies that compared the outcomes of the two approaches.</p> </list-item> <list-item> <p>Outcomes of interest included perioperative and postoperative variables, surgical complications and oncological variables.</p> </list-item> </list> </p> </sec> <sec id="bju11598-sec-1004" sec-type="section"> <title>Results</title> <p> <list id="bju11598-list-0004" list-type="bullet"> <list-item> <p>Twelve studies assessing transperitoneal laparoscopic RN (TLRN) vs retroperitoneal laparoscopic RN (RLRN) and six studies assessing transperitoneal laparoscopic PN (TLPN) vs retroperitoneal laparoscopic PN (RLPN) were included.</p> </list-item> <list-item> <p>The RLRN approach had a shorter time to renal artery control (weighted mean difference [WMD] 68.65 min; 95% confidence interval [CI] 40.80–96.50; <italic>P</italic> < 0.001) and a lower overall complication rate (odds ratio 2.12; 95% CI 1.30–3.47; <italic>P</italic> = 0.003) than TLRN. RLPN had a shorter operating time (WMD 48.85 min; 95% CI 29.33–68.37; <italic>P</italic> < 0.001) and a shorter length of hospital stay (WMD 1.01 days; 95% CI 0.39–1.63; <italic>P</italic> = 0.001) than TLPN.</p> </list-item> <list-item> <p>There were no significant differences between the retroperitoneal and transperitoneal approaches in other outcomes of interest.</p> </list-item> </list> </p> </sec> <sec id="bju11598-sec-1005" sec-type="section"> <title>Conclusions</title> <p> <list id="bju11598-list-0005" list-type="bullet"> <list-item> <p>This meta‐analysis indicates that, in appropriately selected patients, especially patients with posteriorly located renal tumours, the retroperitoneal approach may be faster and equally safe compared with the transperitoneal approach.</p> </list-item> <list-item> <p>Despite our rigorous methodology, conclusions drawn from our pooled results should be interpreted with caution because of the inherent limitations of the included studies.</p> </list-item> </list> </p> </sec> </abstract>