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

• Published in: Arab Journal of Urology Vol. 15; no. 3; pp. 177 - 186
• Main Authors: Stonier, Thomas, Simson, Nick, Lee, Su-Min, Robertson, Ian, Amer, Tarik, Somani, Bhaskar K., Rai, Bhavan P., Aboumarzouk, Omar
• Format: Journal Article
• Language: English
• Published: United States Elsevier B.V 01.09.2017; Taylor & Francis; Elsevier
• Subjects: (L)(RA)NU, (laparoscopic) (robot-assisted) nephroureterectomy; CEBM, Centre for Evidence-Based Medicine; EBL, estimated blood loss; Laparoscopic; LND, lymph node dissection; MeSH, Medical Subject Heading; Nephroureterectomy; OT, operative time; PRISMA, Preferred Reporting Items for Systematic Reviews and Meta-Analyses; PSM, positive surgical margins; Review; Robotic; Ureteric neoplasm ureter; VAS, visual analogue scale; LND; OT; Robotic; MeSH; PRISMA; VAS; Nephroureterectomy; PSM; EBL; Ureteric neoplasm ureter; CEBM; (L)(RA)NU; Laparoscopic; OT, operative time; VAS, visual analogue scale; PRISMA, Preferred Reporting Items for Systematic Reviews and Meta-Analyses; (L)(RA)NU, (laparoscopic) (robot-assisted) nephroureterectomy; EBL, estimated blood loss; CEBM, Centre for Evidence-Based Medicine; PSM, positive surgical margins; MeSH, Medical Subject Heading; LND, lymph node dissection
• ISSN: 2090-598X; 2090-5998; 2090-598X; 2090-5998
• DOI: 10.1016/j.aju.2017.05.002

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. 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. 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 251min, P=0.03; 306 vs 234min, 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). 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.