Robot-assisted versus open partial nephrectomy in patients with a solitary kidney: a systematic review and meta-analysis of perioperative and functional outcomes.
Song Cao, Jiao Qin, Qiang Zhang et al.
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In 30 seconds
This systematic review and meta-analysis compared robot-assisted partial nephrectomy (RAPN) with open partial nephrectomy (OPN) for tumors in a solitary kidney. Four retrospective comparative studies included 333 patients (153 RAPN, 180 OPN). At 12 months, eGFR preservation did not differ significantly (MD = - 3.77%, 95% CI - 10.71 to 3.18, p = 0.287), nor did temporary dialysis or CKD progression. RAPN was associated with shorter warm ischemia, earlier discharge and lower blood loss. The findings suggest potential perioperative advantages but do not establish equivalence or confirm safety and effectiveness.
Key findings
- Twelve-month eGFR preservation was not significantly different between approaches (MD = - 3.77%, 95% CI - 10.71 to 3.18, p = 0.287).
- Temporary postoperative dialysis and CKD stage progression did not differ significantly between RAPN and OPN.
- RAPN was associated with shorter warm ischemia (WMD = - 2.15 min, 95% CI - 4.20 to - 0.09, p = 0.041) and earlier discharge (WMD = - 2.39 days, 95% CI -4.44 to -0.34, p = 0.012 < 0.05).
- Blood loss was lower with RAPN (WMD = - 141.88 mL, 95% CI - 277.40 to - 6.37, p < 0.05); complications and positive surgical margins did not differ significantly.
Why it matters
In a solitary kidney, preserving renal function is a central concern when removing a tumor. These pooled findings indicate that RAPN may offer some perioperative advantages without a detected difference in measured renal outcomes, complications or margins. However, the evidence is too limited to establish that the approaches are equivalent, so the results should inform discussion rather than be treated as definitive comparative evidence.
What to keep in mind
Only four small-sample retrospective studies were included, limiting certainty and leaving potential for bias. The authors call for prospective, higher-quality evidence.