Robot-assisted vs. laparoscopic nephroureterectomy for upper urinary tract urothelial carcinoma: a systematic review and meta-analysis based on comparative studies
BackgroundRobot-assisted nephroureterectomy (RANU) and laparoscopic nephroureterectomy (LNU) are two minimally invasive surgical management for upper urinary tract urothelial carcinomas (UTUC). Though more high-tech, it remains largely unclear whether RANU provides additional benefits over LNU. We a...
| Main Authors: | , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Frontiers Media S.A.
2022-08-01
|
| Series: | Frontiers in Oncology |
| Subjects: | |
| Online Access: | https://www.frontiersin.org/articles/10.3389/fonc.2022.964256/full |
| _version_ | 1818507794127519744 |
|---|---|
| author | Ruoyu Ji Zhangyuting He Shiyuan Fang Wenjie Yang Mengchao Wei Jie Dong Weifeng Xu Zhigang Ji |
| author_facet | Ruoyu Ji Zhangyuting He Shiyuan Fang Wenjie Yang Mengchao Wei Jie Dong Weifeng Xu Zhigang Ji |
| author_sort | Ruoyu Ji |
| collection | DOAJ |
| description | BackgroundRobot-assisted nephroureterectomy (RANU) and laparoscopic nephroureterectomy (LNU) are two minimally invasive surgical management for upper urinary tract urothelial carcinomas (UTUC). Though more high-tech, it remains largely unclear whether RANU provides additional benefits over LNU. We aimed to quantitatively compare the perioperative and oncologic outcomes between RANU and LNU.MethodsThe systematic review was performed based on a registered protocol (registration number CRD42022319086). We searched through PubMed, EMBASE and Cochrane databases, as well as conference proceedings and references of review articles (May 2022) for comparative studies reporting perioperative and oncologic outcomes independently in RANU and LNU groups. Selection of studies and data extraction were performed independently by two researchers. Risk of bias was assessed using the modified Newcastle-Ottawa Scale. Results of random-effects meta-analyses were presented as mean differences (MD) or Odds ratio (OR), as appropriate. Subgroup and univariate meta-regression analyses were performed to identify interstudy heterogeneities.ResultsThe review included 8470 patients undergoing RANU and 19872 patients undergoing LNU from 12 comparative original studies. RANU was associated with fewer overall complications (OR=0.71, 95%CI: 0.62 to 0.81), longer operative time (MD=27.70, 95%CI: 0.83 to 54.60) and shorter length of stay (MD=-0.53, 95%CI: -0.98 to -0.07) compared to LNU. In addition, patients receiving RANU were more likely to have lymph node dissected (OR=2.61, 95%CI: 1.86 to 3.65). Recurrence and survival outcomes did not differ between two surgical procedures. Sample size, types of LNU and world region were major sources of heterogeneity.ConclusionFor UTUC patients, RANU offers fewer complications and shorter hospitalization. However, RANU requires longer operative time and shares similar oncologic outcomes compared to LNU. Further randomized designed studies are warranted.Systematic Review Registrationwww.crd.york.ac.uk/prospero/, identifier CRD42022319086. |
| first_indexed | 2024-12-10T22:22:53Z |
| format | Article |
| id | doaj.art-33aa1ebcf39e443082c8949000f33210 |
| institution | Directory Open Access Journal |
| issn | 2234-943X |
| language | English |
| last_indexed | 2024-12-10T22:22:53Z |
| publishDate | 2022-08-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Oncology |
| spelling | doaj.art-33aa1ebcf39e443082c8949000f332102022-12-22T01:31:15ZengFrontiers Media S.A.Frontiers in Oncology2234-943X2022-08-011210.3389/fonc.2022.964256964256Robot-assisted vs. laparoscopic nephroureterectomy for upper urinary tract urothelial carcinoma: a systematic review and meta-analysis based on comparative studiesRuoyu Ji0Zhangyuting He1Shiyuan Fang2Wenjie Yang3Mengchao Wei4Jie Dong5Weifeng Xu6Zhigang Ji7Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, ChinaPeking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, ChinaPeking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, ChinaDepartment of Urology, Peking Union Medical College Hospital, Beijing, ChinaDepartment of Urology, Peking Union Medical College Hospital, Beijing, ChinaDepartment of Urology, Peking Union Medical College Hospital, Beijing, ChinaDepartment of Urology, Peking Union Medical College Hospital, Beijing, ChinaDepartment of Urology, Peking Union Medical College Hospital, Beijing, ChinaBackgroundRobot-assisted nephroureterectomy (RANU) and laparoscopic nephroureterectomy (LNU) are two minimally invasive surgical management for upper urinary tract urothelial carcinomas (UTUC). Though more high-tech, it remains largely unclear whether RANU provides additional benefits over LNU. We aimed to quantitatively compare the perioperative and oncologic outcomes between RANU and LNU.MethodsThe systematic review was performed based on a registered protocol (registration number CRD42022319086). We searched through PubMed, EMBASE and Cochrane databases, as well as conference proceedings and references of review articles (May 2022) for comparative studies reporting perioperative and oncologic outcomes independently in RANU and LNU groups. Selection of studies and data extraction were performed independently by two researchers. Risk of bias was assessed using the modified Newcastle-Ottawa Scale. Results of random-effects meta-analyses were presented as mean differences (MD) or Odds ratio (OR), as appropriate. Subgroup and univariate meta-regression analyses were performed to identify interstudy heterogeneities.ResultsThe review included 8470 patients undergoing RANU and 19872 patients undergoing LNU from 12 comparative original studies. RANU was associated with fewer overall complications (OR=0.71, 95%CI: 0.62 to 0.81), longer operative time (MD=27.70, 95%CI: 0.83 to 54.60) and shorter length of stay (MD=-0.53, 95%CI: -0.98 to -0.07) compared to LNU. In addition, patients receiving RANU were more likely to have lymph node dissected (OR=2.61, 95%CI: 1.86 to 3.65). Recurrence and survival outcomes did not differ between two surgical procedures. Sample size, types of LNU and world region were major sources of heterogeneity.ConclusionFor UTUC patients, RANU offers fewer complications and shorter hospitalization. However, RANU requires longer operative time and shares similar oncologic outcomes compared to LNU. Further randomized designed studies are warranted.Systematic Review Registrationwww.crd.york.ac.uk/prospero/, identifier CRD42022319086.https://www.frontiersin.org/articles/10.3389/fonc.2022.964256/fullnephroureterectomyrobot-assistedlaparoscopicurothelial carcinomascomplicationstreatment outcome |
| spellingShingle | Ruoyu Ji Zhangyuting He Shiyuan Fang Wenjie Yang Mengchao Wei Jie Dong Weifeng Xu Zhigang Ji Robot-assisted vs. laparoscopic nephroureterectomy for upper urinary tract urothelial carcinoma: a systematic review and meta-analysis based on comparative studies Frontiers in Oncology nephroureterectomy robot-assisted laparoscopic urothelial carcinomas complications treatment outcome |
| title | Robot-assisted vs. laparoscopic nephroureterectomy for upper urinary tract urothelial carcinoma: a systematic review and meta-analysis based on comparative studies |
| title_full | Robot-assisted vs. laparoscopic nephroureterectomy for upper urinary tract urothelial carcinoma: a systematic review and meta-analysis based on comparative studies |
| title_fullStr | Robot-assisted vs. laparoscopic nephroureterectomy for upper urinary tract urothelial carcinoma: a systematic review and meta-analysis based on comparative studies |
| title_full_unstemmed | Robot-assisted vs. laparoscopic nephroureterectomy for upper urinary tract urothelial carcinoma: a systematic review and meta-analysis based on comparative studies |
| title_short | Robot-assisted vs. laparoscopic nephroureterectomy for upper urinary tract urothelial carcinoma: a systematic review and meta-analysis based on comparative studies |
| title_sort | robot assisted vs laparoscopic nephroureterectomy for upper urinary tract urothelial carcinoma a systematic review and meta analysis based on comparative studies |
| topic | nephroureterectomy robot-assisted laparoscopic urothelial carcinomas complications treatment outcome |
| url | https://www.frontiersin.org/articles/10.3389/fonc.2022.964256/full |
| work_keys_str_mv | AT ruoyuji robotassistedvslaparoscopicnephroureterectomyforupperurinarytracturothelialcarcinomaasystematicreviewandmetaanalysisbasedoncomparativestudies AT zhangyutinghe robotassistedvslaparoscopicnephroureterectomyforupperurinarytracturothelialcarcinomaasystematicreviewandmetaanalysisbasedoncomparativestudies AT shiyuanfang robotassistedvslaparoscopicnephroureterectomyforupperurinarytracturothelialcarcinomaasystematicreviewandmetaanalysisbasedoncomparativestudies AT wenjieyang robotassistedvslaparoscopicnephroureterectomyforupperurinarytracturothelialcarcinomaasystematicreviewandmetaanalysisbasedoncomparativestudies AT mengchaowei robotassistedvslaparoscopicnephroureterectomyforupperurinarytracturothelialcarcinomaasystematicreviewandmetaanalysisbasedoncomparativestudies AT jiedong robotassistedvslaparoscopicnephroureterectomyforupperurinarytracturothelialcarcinomaasystematicreviewandmetaanalysisbasedoncomparativestudies AT weifengxu robotassistedvslaparoscopicnephroureterectomyforupperurinarytracturothelialcarcinomaasystematicreviewandmetaanalysisbasedoncomparativestudies AT zhigangji robotassistedvslaparoscopicnephroureterectomyforupperurinarytracturothelialcarcinomaasystematicreviewandmetaanalysisbasedoncomparativestudies |