The primary objective of this meta-analysis was to evaluate and compare the perioperative outcomes of two distinct surgical approaches – transperitoneal robotic partial nephrectomy (TPPN) vs. retroperitoneal robotic partial nephrectomy (RPPN). A systematic search was executed across multiple databases, including MEDLINE, PubMed, Google Scholar, and the Cochrane Database, to identify relevant studies published between January 2000 and January 2025. The analysis included nine propensity score-matched studies involving a total of 2420 patients, with 1321 patients undergoing TPPN and 1099 patients undergoing RPPN.

The findings revealed that RPPN was associated with shorter operating times, reduced hospital stays, less intraoperative blood loss, and a lower rate of overall complications compared to TPPN. However, both groups exhibited no significant differences in several factors, including renal ischemia duration, postoperative glomerular filtration rate (GFR) decline, serious complications, and the need for blood transfusions. The study concluded that RPPN presents certain advantages in perioperative metrics, albeit emphasizing the necessity for further high-quality studies to validate these outcomes.

Introduction

Renal cancer has seen an annual increase of approximately 2%, positioning it as the eighth most common cancer globally. Many cases are detected incidentally through non-invasive imaging, particularly small renal masses (SRMs) measuring less than 4 cm, which constitute about 50% of all renal cancer occurrences. Partial nephrectomy (PN) has become the standard treatment for SRMs, as it ensures favourable oncological outcomes while preserving long-term renal function, thereby enhancing patients’ quality of life and survival rates.

The advent of robotic-assisted partial nephrectomy (RPN) since its inception in 2004 has revolutionized the approach to treating localized kidney cancers. Although both RPN and open partial nephrectomy (OPN) yield comparable oncological results, RPN is associated with fewer complications, reduced blood loss, and shorter hospital stays. The debate continues regarding the optimal surgical approach between RPPN and TPPN, underscoring the need to weigh their respective benefits and drawbacks.

Methods

The study adhered to the PRISMA guidelines for systematic reviews and meta-analyses. It exclusively analysed propensity score-matched studies that compared transperitoneal vs retroperitoneal robotic partial nephrectomy concerning perioperative outcomes. A comprehensive literature search identified relevant studies, which were then evaluated based on predetermined inclusion and exclusion criteria. Data extraction focused on patient demographics, tumour details, and perioperative outcomes, ensuring a thorough analysis of the collected data.

Statistical analyses were conducted using Review Manager software, applying a random-effects model to account for variability across studies. The evaluation of heterogeneity was accomplished using the I² statistic, with a p-value of less than 0.05 considered statistically significant.

Results

The meta-analysis encompassed nine studies, totalling 2420 patients, with a nearly equal distribution between TPPN and RPPN. The findings revealed that RPPN is associated with significantly lower length of hospital stay (LOHS) and shorter operating time (OT). Specifically, RPPN demonstrated a mean decrease in LOHS and OT, reaffirming its efficiency over TPPN. Furthermore, RPPN was linked to a reduction in estimated blood loss (EBL), indicating its potential for minimizing intraoperative complications.

However, the analysis found no significant differences in serious complications, transfusion requirements, or postoperative GFR decline between the two surgical approaches, suggesting that while RPPN offers perioperative advantages, it does not compromise patient safety regarding serious adverse outcomes.

Discussion

The outcomes of this meta-analysis highlight that RPPN may provide distinct benefits over TPPN, including reduced operating times and hospital stays, as well as lower overall complication rates. The anatomical advantages of RPPN, which allows for direct access to the renal artery and minimizes bowel manipulation, may contribute to these favourable results. However, it is essential to consider the technical challenges associated with RPPN, which may limit its applicability based on surgeon expertise and patient factors.

While the findings are promising, the authors stress the importance of conducting further high-quality randomized controlled trials with longer follow-up periods to validate these results comprehensively.

Conclusions

In summary, RPPN appears to confer certain perioperative advantages compared to TPPN, particularly in terms of shorter operating times, reduced hospital stays, and lower complication rates. Nonetheless, the necessity for additional rigorous studies remains imperative to substantiate these findings and to explore the long-term efficacy of RPPN in treating renal masses.

READ MORE… https://link.springer.com/article/10.1007/s11701-025-02217-4

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