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Robotic‐assisted versus laparoscopic nephroureterectomy; a systematic review and meta‐analysis

BACKGROUND: Upper tract urothelial carcinoma (UTUC) is the malignant transformation of urothelial cells, from the renal calyces to the ureteral orifices. While the benefits of minimally invasive nephroureterectomy over their open counterpart have been established, the optimal technique remains a deb...

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Autores principales: O'Sullivan, Niall J., Naughton, Ailish, Temperley, Hugo C., Casey, Rowan G.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: John Wiley and Sons Inc. 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10071076/
https://www.ncbi.nlm.nih.gov/pubmed/37025468
http://dx.doi.org/10.1002/bco2.208
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author O'Sullivan, Niall J.
Naughton, Ailish
Temperley, Hugo C.
Casey, Rowan G.
author_facet O'Sullivan, Niall J.
Naughton, Ailish
Temperley, Hugo C.
Casey, Rowan G.
author_sort O'Sullivan, Niall J.
collection PubMed
description BACKGROUND: Upper tract urothelial carcinoma (UTUC) is the malignant transformation of urothelial cells, from the renal calyces to the ureteral orifices. While the benefits of minimally invasive nephroureterectomy over their open counterpart have been established, the optimal technique remains a debate. We aimed to assess current evidence in the literature and compare outcomes between robotic‐assisted (RANU) and laparoscopic nephroureterectomy (LNU). METHODS: A systematic review of the literature was performed for studies comparing RANU and LNU for bladder cancer. Outcome measurements were recurrence rates (local and distal), positive margins, positive lymph node yield and perioperative outcomes. Meta‐analysis was performed using Review Manager 5. RESULTS: Our results demonstrate a significantly higher mortality rate in patients undergoing laparoscopic nephroureterectomy when compared with the robotic‐assisted approach for the treatment of UTUC (1.8% vs. 1.1%, p = 0.008); however, these results were inconsistent on sensitivity analysis and should therefore be interpreted with caution. No significant difference was observed for other outcomes. CONCLUSION: The ideal approach to minimally invasive radical nephroureterectomy remains undetermined. Future research, ideally prospective randomised studies, should focus on long‐term outcomes, in particular recurrence, recurrence‐free survival, overall survival and the correlation between surgical technique and survival.
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spelling pubmed-100710762023-04-05 Robotic‐assisted versus laparoscopic nephroureterectomy; a systematic review and meta‐analysis O'Sullivan, Niall J. Naughton, Ailish Temperley, Hugo C. Casey, Rowan G. BJUI Compass Reviews BACKGROUND: Upper tract urothelial carcinoma (UTUC) is the malignant transformation of urothelial cells, from the renal calyces to the ureteral orifices. While the benefits of minimally invasive nephroureterectomy over their open counterpart have been established, the optimal technique remains a debate. We aimed to assess current evidence in the literature and compare outcomes between robotic‐assisted (RANU) and laparoscopic nephroureterectomy (LNU). METHODS: A systematic review of the literature was performed for studies comparing RANU and LNU for bladder cancer. Outcome measurements were recurrence rates (local and distal), positive margins, positive lymph node yield and perioperative outcomes. Meta‐analysis was performed using Review Manager 5. RESULTS: Our results demonstrate a significantly higher mortality rate in patients undergoing laparoscopic nephroureterectomy when compared with the robotic‐assisted approach for the treatment of UTUC (1.8% vs. 1.1%, p = 0.008); however, these results were inconsistent on sensitivity analysis and should therefore be interpreted with caution. No significant difference was observed for other outcomes. CONCLUSION: The ideal approach to minimally invasive radical nephroureterectomy remains undetermined. Future research, ideally prospective randomised studies, should focus on long‐term outcomes, in particular recurrence, recurrence‐free survival, overall survival and the correlation between surgical technique and survival. John Wiley and Sons Inc. 2023-01-22 /pmc/articles/PMC10071076/ /pubmed/37025468 http://dx.doi.org/10.1002/bco2.208 Text en © 2023 The Authors. BJUI Compass published by John Wiley & Sons Ltd on behalf of BJU International Company. https://creativecommons.org/licenses/by/4.0/This is an open access article under the terms of the http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.
spellingShingle Reviews
O'Sullivan, Niall J.
Naughton, Ailish
Temperley, Hugo C.
Casey, Rowan G.
Robotic‐assisted versus laparoscopic nephroureterectomy; a systematic review and meta‐analysis
title Robotic‐assisted versus laparoscopic nephroureterectomy; a systematic review and meta‐analysis
title_full Robotic‐assisted versus laparoscopic nephroureterectomy; a systematic review and meta‐analysis
title_fullStr Robotic‐assisted versus laparoscopic nephroureterectomy; a systematic review and meta‐analysis
title_full_unstemmed Robotic‐assisted versus laparoscopic nephroureterectomy; a systematic review and meta‐analysis
title_short Robotic‐assisted versus laparoscopic nephroureterectomy; a systematic review and meta‐analysis
title_sort robotic‐assisted versus laparoscopic nephroureterectomy; a systematic review and meta‐analysis
topic Reviews
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10071076/
https://www.ncbi.nlm.nih.gov/pubmed/37025468
http://dx.doi.org/10.1002/bco2.208
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