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<p>To contrast the clinical efficacy and safety of laparoscopic partial nephrectomy (LPN) and robot-assisted partial nephrectomy (RAPN) for moderate-to-high complexity renal tumors (RENAL nephrometry score ≥ 7). EMBASE, Cochrane Library, Web of Science databases, and PubMed were retrieved until November 2025. To pool the data, we used Stata 18.0 and Review Manager 5.4. Additionally, the Newcastle-Ottawa Scale (NOS) was used to evaluate the quality of the research. Funnel plot visualization analysis and Egger’s statistical test were employed to assess publication bias. In total, 1622 patients (LPN:789; RAPN:833) were included in this meta-analysis, including eleven observational studies. Relative to RAPN, LPN had a prolonged operative time (OT)(weight mean difference[WMD] = 13.03&#xa0;min;95%CI:5.63,20.43;<i>p</i> = 0006), longer length of stay (LOS) (WMD = 0.63days;95%CI:0.38,0.88;<i>p</i> &lt; 0.00001), longer warm ischemia time (WIT) (WMD = 3.84&#xa0;min;95%CI:2.06,5.62;<i>p</i> &lt; 0.0001), higher conversion rate to radical nephrectomy (RN) (OR = 3.14;95%CI:1.64,6.01;<i>p</i> = 0.0006), higher intraoperative complications rates (OR = 1.91;95%CI:1.03,3.53;<i>p</i> = 0.04), higher postoperative complications rates (OR = 1.29;95%CI:1.01,1.64;<i>p</i> = 0.04), greater postoperative decline in estimated glomerular filtration rate (eGFR) (WMD = 2.58mL/min/1.73&#xa0;m²;95%CI:1.40,3.77;<i>p</i> &lt; 0.0001). There existed no statistically significant intergroup disparities in any of the measured results, encompassing estimated blood loss (EBL), transfusion, local recurrence, and positive surgical margin (PSM) (all <i>p</i> &gt; 0.05). Patients suffering through moderate-to-high complexity renal tumors (RENAL-NS ≥ 7), RAPN showed that it was more effective than LPN in lowering OT, WIT, LOS, intraoperative and postoperative complications rates, conversion rate to RN. It also shows a tendency to alleviate the decline of early renal function outcomes, which provides an important reference for clinical decision-making. However, the level of evidence is still limited by the potential risk of bias in the included studies. Therefore, additional validation using higher-level data, such as large-scale prospective randomized trials, should validate the results of this study.</p>

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Efficacy and safety of laparoscopic versus robot-assisted partial nephrectomy for moderate-to-high complexity renal tumors (RENAL-NS ≥ 7): a systematic review and meta-analysis

  • 期刊论文

  • 发表日期：

    2026年2月26日

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  • Yuxin Zhao,
  • MD AL AMIN,
  • Gen Fan,
  • Yushui Chen,
  • Shu Cui,
  • Tao Wu

摘要

To contrast the clinical efficacy and safety of laparoscopic partial nephrectomy (LPN) and robot-assisted partial nephrectomy (RAPN) for moderate-to-high complexity renal tumors (RENAL nephrometry score ≥ 7). EMBASE, Cochrane Library, Web of Science databases, and PubMed were retrieved until November 2025. To pool the data, we used Stata 18.0 and Review Manager 5.4. Additionally, the Newcastle-Ottawa Scale (NOS) was used to evaluate the quality of the research. Funnel plot visualization analysis and Egger’s statistical test were employed to assess publication bias. In total, 1622 patients (LPN:789; RAPN:833) were included in this meta-analysis, including eleven observational studies. Relative to RAPN, LPN had a prolonged operative time (OT)(weight mean difference[WMD] = 13.03 min;95%CI:5.63,20.43;p = 0006), longer length of stay (LOS) (WMD = 0.63days;95%CI:0.38,0.88;p < 0.00001), longer warm ischemia time (WIT) (WMD = 3.84 min;95%CI:2.06,5.62;p < 0.0001), higher conversion rate to radical nephrectomy (RN) (OR = 3.14;95%CI:1.64,6.01;p = 0.0006), higher intraoperative complications rates (OR = 1.91;95%CI:1.03,3.53;p = 0.04), higher postoperative complications rates (OR = 1.29;95%CI:1.01,1.64;p = 0.04), greater postoperative decline in estimated glomerular filtration rate (eGFR) (WMD = 2.58mL/min/1.73 m²;95%CI:1.40,3.77;p < 0.0001). There existed no statistically significant intergroup disparities in any of the measured results, encompassing estimated blood loss (EBL), transfusion, local recurrence, and positive surgical margin (PSM) (all p > 0.05). Patients suffering through moderate-to-high complexity renal tumors (RENAL-NS ≥ 7), RAPN showed that it was more effective than LPN in lowering OT, WIT, LOS, intraoperative and postoperative complications rates, conversion rate to RN. It also shows a tendency to alleviate the decline of early renal function outcomes, which provides an important reference for clinical decision-making. However, the level of evidence is still limited by the potential risk of bias in the included studies. Therefore, additional validation using higher-level data, such as large-scale prospective randomized trials, should validate the results of this study.