Robot-assisted vs. laparoscopic nephroureterectomy for upper urinary tract urothelial carcinoma: a systematic review and meta-analysis based on comparative studies

Abstract

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.

Early experience and future prospects regarding use of newly developed surgical robot system, hinotori, in the field of urologic cancer surgery

“…Since the initial report in 2006 [ 36 ] and the subsequent studies presenting technical refinements [ 37 , 38 ], RANU has been regarded as one of the standard surgical options for patients with upper urinary tract cancer in routine clinical practice, and recent studies have clarified several advantages of RANU over other approaches, including open and laparoscopic surgeries [ 39 , 40 ]. At our institution, following the introduction of RANU using da Vinci Xi, RANU with the use of hinotori was started, and after accumulating experience of RANU using hinotori for eight patients, initial experience of this surgery was reported [ 12 ].…”

Systematic review and meta-analysis of completely retroperitoneoscopic nephroureterectomy versus traditional retroperitoneoscopic nephroureterectomy in upper tract urothelial carcinoma

“…While robotic-assisted laparoscopic technique may have some advantages over tRNU, TRNU or ONU, including less blood loss and higher success rates, it is associated with higher costs and no advantages in some aspects such as mortality, operative time, recurrence, distant metastasis, and overall survival. [9][10][11] Therefore, laparoscopic techniques, including remain important and commonly performed in hospitals. In the current meta-analysis, our results indicate that CRNU has advantages over TRNU, suggesting that CRNU may have an important position in laparoscopic techniques.…”

“…Similarly, the robotic-assisted laparoscopic technique also faces the same challenges as the total tRNU, despite its potential as a game changer. [9][10][11] Moreover, the transperitoneal approach has been shown to have poorer outcomes than the retroperitoneal approach. [12] Therefore, there is a need for a completely retroperitoneoscopic nephroureterectomy (CRNU) technique.…”

Standardization of Robot-Assisted Radical Nephroureterectomy via Intraperitoneal Approach: Insights from a High-Volume Japanese Center

“…In Japan, the inclusion of robot-assisted radical nephroureterectomy (RANU) under the National Health Insurance scheme, overseen by the Ministry of Health, Labour and Welfare, commenced in April 2022. While there is some international data available on RANU, 1,2 the corresponding Japanese domestic data remains insu cient. This document delineates the standardization of the RANU protocol within urology team executing 371 robot-assisted operations in scal year 2023.…”