Filippo Caudana, Mattia Ronca, Francesco Ditonno, Greta Pettenuzzo, Celeste Manfredi, Alessandro Veccia, Riccardo Giuseppe Bertolo, Gaëlle Margue, Riccardo Autorino, Jean-Christophe Bernhard, Alessandro Antonelli
RARN-TT may reduce blood loss, transfusion requirements, and hospital stay compared with ORN-TT, without evidence of worse perioperative, pathological, or survival outcomes. However, all studies were retrospective and affected by selection bias and heterogeneity. RARN-TT may be considered for selected patients at experienced centers, particularly for lower-level thrombi. Prospective multicenter studies stratified by thrombus level are needed.
BACKGROUND/OBJECTIVES: To compare perioperative, pathological, functional, and oncological outcomes of robot-assisted radical nephrectomy with inferior vena cava tumor thrombectomy (RARN-TT) versus open (ORN-TT) and laparoscopic (LRN-TT) approaches.
METHODS: PubMed, Scopus, and Web of Science were searched for studies of adults with renal cell carcinoma and Mayo/Neves level I-IV inferior vena cava tumor thrombus undergoing RARN-TT versus ORN-TT and/or LRN-TT. Risk ratios and mean differences with 95% confidence intervals were calculated using random effects models with restricted maximum-likelihood estimation.
RESULTS: Eight retrospective studies including 1781 patients were included: 221 underwent robotic surgery, 1411 open surgery, and 149 laparoscopic surgery. Compared with ORN-TT, RARN-TT was associated with lower estimated blood loss (mean difference -900.5 mL, 95% confidence interval -1234.0 to -566.9; p = 0.001), lower transfusion probability (risk ratio 0.395, 95% confidence interval 0.159-0.979; p = 0.046), and shorter hospital stay (mean difference -3.79 days, 95% confidence interval -4.83 to -2.76; p < 0.001). No significant differences were observed in operative time, intensive care unit stay, postoperative complications, perioperative mortality, pathological outcomes, or overall survival. Evidence for cancer-specific and progression-free survival was limited. Comparisons with LRN-TT were exploratory.
CONCLUSIONS: RARN-TT may reduce blood loss, transfusion requirements, and hospital stay compared with ORN-TT, without evidence of worse perioperative, pathological, or survival outcomes. However, all studies were retrospective and affected by selection bias and heterogeneity. RARN-TT may be considered for selected patients at experienced centers, particularly for lower-level thrombi. Prospective multicenter studies stratified by thrombus level are needed.