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Laparoscopic vs robotic nephroureterectomy: is it time to re-establish the standard? Evidence from a systematic review

Laparoscopic vs robotic nephroureterectomy: is it time to re-establish the standard? Evidence from a systematic review
Laparoscopic vs robotic nephroureterectomy: is it time to re-establish the standard? Evidence from a systematic review

OBJECTIVE: To conduct a systematic review of comparative studies of laparoscopic nephroureterectomy (LNU), the standard management for upper urothelial tumours, and robot-assisted NU (RANU) that has emerged as a viable alternative.

METHODS: MEDLINE, EMBASE and the Cochrane Library were searched according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines to identify all studies reporting on both LNU and RANU for upper urothelial tract tumours.

RESULTS: In all, 1630 patients were included, of which 838 underwent LNU and 792 RANU. Three studies reported on mean operative time and found it to be less in LNU, with two reporting this to be significant (RANU 298 vs LNU 251 min,P = 0.03; 306 vs 234 min, respectively,P < 0.001). Both studies reporting on median node count found this to be higher in the robotic groups: RANU 5.5 vs LNU 1.0 and RANU 21 vs LNU 11. Positive surgical margins (RANU 1.69% vs LNU 7.06%,P = 0.18), bladder recurrence (24.6% vs 36.89%,P = 0.09), and distant metastases (27.50% vs 17.50%,P = 0.29) were not significantly different between the two techniques. Disease-specific mortality did not differ between the two techniques (RANU 7.5% vs LNU 12.5%,P = 0.46), but postoperative mortality was reduced in RANU (0.14% vs 1.32%,P = 0.03). Overall complication rates were statistically lower in RANU, at 12.5% vs 18.8% (P < 0.001).

CONCLUSIONS: This review suggests these techniques are equivalent in terms of perioperative and oncological performance. Furthermore, there may be a lower overall complication rate, as well as postoperative mortality in the robotic group. Further research in the form of a randomised controlled trial is warranted.

Journal Article, Review
2090-598X
177-186
Stonier, Thomas
0c9298ed-72a1-4766-bec3-a0d65eac3788
Simson, Nick
5570a9cd-9cc4-4e65-9dd5-49e2ad8eb938
Lee, Su-Min
bc8b5ec4-8011-4271-88dc-bfeb7c19a373
Robertson, Ian
e846d26f-eff4-497f-be06-98d42f3424d3
Amer, Tarik
34b3aacc-a0bb-4f35-ae65-6808574e6c1f
Somani, Bhaskar K.
ab5fd1ce-02df-4b88-b25e-8ece396335d9
Rai, Bhavan P.
e1156207-bfd1-4f89-b0aa-9e55fc54235b
Aboumarzouk, Omar
3c7e2433-638d-4378-9931-902fdc68acce
Stonier, Thomas
0c9298ed-72a1-4766-bec3-a0d65eac3788
Simson, Nick
5570a9cd-9cc4-4e65-9dd5-49e2ad8eb938
Lee, Su-Min
bc8b5ec4-8011-4271-88dc-bfeb7c19a373
Robertson, Ian
e846d26f-eff4-497f-be06-98d42f3424d3
Amer, Tarik
34b3aacc-a0bb-4f35-ae65-6808574e6c1f
Somani, Bhaskar K.
ab5fd1ce-02df-4b88-b25e-8ece396335d9
Rai, Bhavan P.
e1156207-bfd1-4f89-b0aa-9e55fc54235b
Aboumarzouk, Omar
3c7e2433-638d-4378-9931-902fdc68acce

Stonier, Thomas, Simson, Nick, Lee, Su-Min, Robertson, Ian, Amer, Tarik, Somani, Bhaskar K., Rai, Bhavan P. and Aboumarzouk, Omar (2017) Laparoscopic vs robotic nephroureterectomy: is it time to re-establish the standard? Evidence from a systematic review. Arab Journal of Urology, 15 (3), 177-186. (doi:10.1016/j.aju.2017.05.002).

Record type: Review

Abstract

OBJECTIVE: To conduct a systematic review of comparative studies of laparoscopic nephroureterectomy (LNU), the standard management for upper urothelial tumours, and robot-assisted NU (RANU) that has emerged as a viable alternative.

METHODS: MEDLINE, EMBASE and the Cochrane Library were searched according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines to identify all studies reporting on both LNU and RANU for upper urothelial tract tumours.

RESULTS: In all, 1630 patients were included, of which 838 underwent LNU and 792 RANU. Three studies reported on mean operative time and found it to be less in LNU, with two reporting this to be significant (RANU 298 vs LNU 251 min,P = 0.03; 306 vs 234 min, respectively,P < 0.001). Both studies reporting on median node count found this to be higher in the robotic groups: RANU 5.5 vs LNU 1.0 and RANU 21 vs LNU 11. Positive surgical margins (RANU 1.69% vs LNU 7.06%,P = 0.18), bladder recurrence (24.6% vs 36.89%,P = 0.09), and distant metastases (27.50% vs 17.50%,P = 0.29) were not significantly different between the two techniques. Disease-specific mortality did not differ between the two techniques (RANU 7.5% vs LNU 12.5%,P = 0.46), but postoperative mortality was reduced in RANU (0.14% vs 1.32%,P = 0.03). Overall complication rates were statistically lower in RANU, at 12.5% vs 18.8% (P < 0.001).

CONCLUSIONS: This review suggests these techniques are equivalent in terms of perioperative and oncological performance. Furthermore, there may be a lower overall complication rate, as well as postoperative mortality in the robotic group. Further research in the form of a randomised controlled trial is warranted.

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More information

Accepted/In Press date: 9 May 2017
e-pub ahead of print date: 16 June 2017
Published date: 1 September 2017
Keywords: Journal Article, Review

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Local EPrints ID: 418995
URI: http://eprints.soton.ac.uk/id/eprint/418995
ISSN: 2090-598X
PURE UUID: 90780e2d-8d06-44e0-a584-0bdcaedc3757

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Date deposited: 27 Mar 2018 16:30
Last modified: 06 Oct 2020 21:39

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