Skip to main content
SpringerLink
Log in

Outcomes of Laparoscopic and Robotic Partial Nephrectomy for Large (>4 Cm) Kidney Tumors: Systematic Review and Meta-Analysis

  • Urologic Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Purpose

The aim of this study was to assess the outcomes of minimally invasive (laparoscopic and robotic) partial nephrectomy (MIPN) for large renal masses.

Materials and Methods

A systematic literature review was performed up to September 2016 using multiple search engines to identify studies comparing MIPN for tumors larger than 4 cm (>cT1a) with MIPN for tumors smaller than 4 cm (cT1a). The preferred reporting items for systematic reviews and meta-analyses (PRISMA) criteria were used for article selection. Baseline demographics and surgical, functional, and oncological parameters were extracted from the included studies whenever available. An overall analysis including all studies was performed, then sensitivity analyses were performed for studies on laparoscopic partial nephrectomy (PN) only, and, finally, for studies on robotic PN only.

Results

Overall, 13 case-control studies comparing the outcomes of PN in tumors <4 cm (n = 4441) with those of PN for tumors >4 cm (n = 1024) were included. Warm ischemia time was shorter for the <4 cm group [weighted mean difference (WMD) 3.75 min; 95% confidence interval (CI) −6.4 to −0.7; p = 0.01] and the odds of perioperative complications was lower [odds ratio (OR) 0.62; 95% CI 0.5–0.8; p < 0.001]. There were no significant differences in terms of postoperative estimated glomerular filtration rate (WMD 4.2 ml/min; 95% CI 0.45–8.97; p = 0.08), as well as onset of postoperative chronic kidney disease (risk ratio 0.71; 95% CI 0.48–1.04; p = 0.08). In addition, no difference was found in the likelihood of positive surgical margins (OR 0.74; 95% CI 0.43–1.28; p = 0.29).

Conclusions

MIPN represents a viable treatment option for renal masses larger than 4 cm (higher than cT1a) as it offers good functional outcomes, without increased risk of positive surgical margins. An increased rate of complications should be taken into account when approaching these tumors.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

References

  1. Campbell SC, Novick AC, Belldegrun A, Blute ML, Chow GK, Derweesh IH, et al. Guideline for management of the clinical T1 renal mass. J Urol. 2009;182(4):1271–9.

    Article  PubMed  Google Scholar 

  2. Ljungberg B, Bensalah K, Canfield S, Dabestani S, Hofmann F, Hora M, et al. EAU guidelines on renal cell carcinoma: 2014 update. Eur Urol. 2015;67(5):913–24.

    Article  PubMed  Google Scholar 

  3. Patard JJ, Shvarts O, Lam JS, Pantuck AJ, Kim HL, Ficarra V, et al. Safety and efficacy of partial nephrectomy for all T1 tumors based on an international multicenter experience. J Urol. 2004;171(6 Pt 1):2181–5; quiz 435.

  4. Leibovich BC, Blute M, Cheville JC, Lohse CM, Weaver AL, Zincke H. Nephron sparing surgery for appropriately selected renal cell carcinoma between 4 and 7 cm results in outcome similar to radical nephrectomy. J Urol. 2004;171(3):1066–70.

    Article  PubMed  Google Scholar 

  5. Antonelli A, Ficarra V, Bertini R, Carini M, Carmignani G, Corti S, et al. Elective partial nephrectomy is equivalent to radical nephrectomy in patients with clinical T1 renal cell carcinoma: results of a retrospective, comparative, multi-institutional study. BJU Int. 2012;109(7):1013–8.

    Article  PubMed  Google Scholar 

  6. Kopp RP, Mehrazin R, Palazzi KL, Liss MA, Jabaji R, Mirheydar HS, et al. Survival outcomes after radical and partial nephrectomy for clinical T2 renal tumours categorised by R.E.N.A.L. nephrometry score. BJU Int. 2014;114(5):708–18.

    Article  PubMed  Google Scholar 

  7. Simmons MN, Chung BI, Gill IS. Perioperative efficacy of laparoscopic partial nephrectomy for tumors larger than 4 cm. Eur Urol. 2009;55(1):199–207.

    Article  PubMed  Google Scholar 

  8. Rais-Bahrami S, Romero FR, Lima GC, Kohanim S, Permpongkosol S, Trock BJ, et al. Elective laparoscopic partial nephrectomy in patients with tumors > 4 cm. Urology. 2008;72(3):580–3.

    Article  PubMed  Google Scholar 

  9. Nouralizadeh A, Simforoosh N, Tabibi A, Basiri A, Ziaee SA, Soleimani M, et al. Laparoscopic partial nephrectomy for tumours > 4 cm compared with smaller tumours: perioperative results. Int Urol Nephrol. 2011;43(2):371–6.

    Article  CAS  PubMed  Google Scholar 

  10. Eng MK, Bernstein AJ, Katz MH, Shikanov S, Zorn KC, Shalhav AL. Impact of renal lesion size on perioperative and pathologic outcomes in patients undergoing laparoscopic partial nephrectomy. J Endourol. 2009;23(3):439–43.

    Article  PubMed  Google Scholar 

  11. Gill IS, Kavoussi LR, Lane BR, Blute ML, Babineau D, Colombo JR Jr, et al. Comparison of 1,800 laparoscopic and open partial nephrectomies for single renal tumors. J Urol. 2007;178(1):41–6.

    Article  PubMed  Google Scholar 

  12. Janda G, Deal A, Yang H, Nielsen M, Smith A, Pruthi RS, et al. Single-institution experience with robotic partial nephrectomy for renal masses greater than 4 cm. J Endourol. 2016;30(4):384–9.

    Article  PubMed  Google Scholar 

  13. Ficarra V, Bhayani S, Porter J, Buffi N, Lee R, Cestari A, et al. Robot-assisted partial nephrectomy for renal tumors larger than 4 cm: results of a multicenter, international series. World J Urol. 2012;30(5):665–70.

    Article  PubMed  Google Scholar 

  14. Kim DK, Kim LH, Raheem AA, Shin TY, Alabdulaali I, Yoon YE, et al. Comparison of trifecta and pentafecta outcomes between T1a and T1b renal masses following robot-assisted partial nephrectomy (RAPN) with minimum one year follow up: can RAPN for T1b renal masses be feasible? PloS One. 2016;11(3):e0151738.

    Article  PubMed  PubMed Central  Google Scholar 

  15. Centre for Evidence-Based Medicine. Explanation of the 2011 OCEBM Levels of Evidence. Available at: http://www.cebm.net/explanation-2011-ocebm-levels-evidence/

  16. The Ottawa Hospital Research Institute. The Newcastle-Ottawa Scale (NOS) for assessing the quality of nonrandomised studies in meta-analyses. http://www.ohri.ca/programs/clinical_epidemiology/oxford.asp

  17. Kutikov A, Uzzo RG. The R.E.N.A.L. nephrometry score: a comprehensive standardized system for quantitating renal tumor size, location and depth. J Urol. 2009;182(3):844–53.

    Article  PubMed  Google Scholar 

  18. Lifshitz DA, Shikanov SA, Deklaj T, Katz MH, Zorn KC, Shalhav AL. Laparoscopic partial nephrectomy for tumors larger than 4 cm: a comparative study. J Endourol. 2010;24(1):49–55.

    Article  PubMed  Google Scholar 

  19. Porpiglia F, Fiori C, Bertolo R, Scarpa RM. Does tumour size really affect the safety of laparoscopic partial nephrectomy? BJU Int. 2011;108(2):268–73.

    Article  PubMed  Google Scholar 

  20. Petros F, Sukumar S, Haber GP, Dulabon L, Bhayani S, Stifelman M, et al. Multi-institutional analysis of robot-assisted partial nephrectomy for renal tumors > 4 cm versus </= 4 cm in 445 consecutive patients. J Endourol. 2012;26(6):642–6.

    Article  PubMed  Google Scholar 

  21. Tiu A, Kim KH, Shin TY, Han WK, Han SW, Rha KH. Feasibility of robotic laparoendoscopic single-site partial nephrectomy for renal tumors > 4 cm. Eur Urol. 2013;63(5):941–6.

    Article  PubMed  Google Scholar 

  22. Patel MN, Krane LS, Bhandari A, Laungani RG, Shrivastava A, Siddiqui SA, et al. Robotic partial nephrectomy for renal tumors larger than 4 cm. Eur Urol. 2010;57(2):310–6.

    Article  PubMed  Google Scholar 

  23. Papalia R, Simone G, Ferriero M, Guaglianone S, Costantini M, Giannarelli D, et al. Laparoscopic and robotic partial nephrectomy without renal ischaemia for tumours larger than 4 cm: perioperative and functional outcomes. World J Urol. 2012;30(5):671–6.

    Article  PubMed  Google Scholar 

  24. Mir MC, Pavan N, Parekh DJ. Current paradigm for ischemia in kidney surgery. J Urol. 2016;195(6):1655–63.

    Article  PubMed  Google Scholar 

  25. Parekh DJ, Weinberg JM, Ercole B, Torkko KC, Hilton W, Bennett M, et al. Tolerance of the human kidney to isolated controlled ischemia. J Am Soc Nephrol. 2013;24(3):506–17.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  26. Volpe A, Blute ML, Ficarra V, Gill IS, Kutikov A, Porpiglia F, et al. Renal ischemia and function after partial nephrectomy: a collaborative review of the literature. Eur Urol. 2015;68(1):61–74.

    Article  PubMed  Google Scholar 

  27. Patard JJ, Pantuck AJ, Crepel M, Lam JS, Bellec L, Albouy B, et al. Morbidity and clinical outcome of nephron-sparing surgery in relation to tumour size and indication. Eur Urol. 2007;52(1):148–54.

    Article  PubMed  Google Scholar 

  28. Scosyrev E, Messing EM, Sylvester R, Campbell S, Van Poppel H. Renal function after nephron-sparing surgery versus radical nephrectomy: results from EORTC randomized trial 30904. Eur Urol. 2014;65(2):372–7.

    Article  PubMed  Google Scholar 

  29. Sun M, Bianchi M, Hansen J, Trinh QD, Abdollah F, Tian Z, et al. Chronic kidney disease after nephrectomy in patients with small renal masses: a retrospective observational analysis. Eur Urol. 2012;62(4):696–703.

    Article  PubMed  Google Scholar 

  30. Mir MC, Derweesh I, Porpiglia F, Zargar H, Mottrie A, Autorino R. Partial nephrectomy versus radical nephrectomy for clinical T1b and T2 renal tumors: a systematic review and meta-analysis of comparative studies. Eur Urol. 2017;71(4):606–617.

    Article  PubMed  Google Scholar 

  31. Pahernik S, Roos F, Rohrig B, Wiesner C, Thuroff JW. Elective nephron sparing surgery for renal cell carcinoma larger than 4 cm. J Urol. 2008;179(1):71–4; discussion 4.

  32. Marszalek M, Carini M, Chlosta P, Jeschke K, Kirkali Z, Knuchel R, et al. Positive surgical margins after nephron-sparing surgery. Eur Urol. 2012;61(4):757–63.

    Article  PubMed  Google Scholar 

  33. Bensalah K, Pantuck AJ, Rioux-Leclercq N, Thuret R, Montorsi F, Karakiewicz PI, et al. Positive surgical margin appears to have negligible impact on survival of renal cell carcinomas treated by nephron-sparing surgery. Eur Urol. 2010;57(3):466–71.

    Article  PubMed  Google Scholar 

  34. Khalifeh A, Kaouk JH, Bhayani S, Rogers C, Stifelman M, Tanagho YS, et al. Positive surgical margins in robot-assisted partial nephrectomy: a multi-institutional analysis of oncologic outcomes (leave no tumor behind). J Urol. 2013;190(5):1674–9.

    Article  PubMed  Google Scholar 

  35. Shah PH, Moreira DM, Okhunov Z, Patel VR, Chopra S, Razmaria AA, et al. Positive surgical margins increase risk of recurrence after partial nephrectomy for high risk renal tumors. J Urol. 2016;196(2):327–34.

    Article  PubMed  Google Scholar 

  36. Zwahlen M, Renehan A, Egger M. Meta-analysis in medical research: potentials and limitations. Urol Oncol. 2008;26(3):320–9.

    Article  PubMed  Google Scholar 

  37. Schiavina R, Novara G, Borghesi M, Ficarra V, Ahlawat R, Moon DA, et al. PADUA and R.E.N.A.L. nephrometry scores correlate with perioperative outcomes of robot-assisted partial nephrectomy: analysis of the Vattikuti Global Quality Initiative in Robotic Urologic Surgery (GQI-RUS) database. BJU Int. 2017;119(3):456–463.

    Article  PubMed  Google Scholar 

  38. Patel HD, Mullins JK, Pierorazio PM, Jayram G, Cohen JE, Matlaga BR, et al. Trends in renal surgery: robotic technology is associated with increased use of partial nephrectomy. J Urol. 2013;189(4):1229–35.

    Article  PubMed  Google Scholar 

  39. Corcoran AT, Russo P, Lowrance WT, Asnis-Alibozek A, Libertino JA, Pryma DA, et al. A review of contemporary data on surgically resected renal masses: benign or malignant? Urology. 2013;81(4):707–13.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Urology Clinic, Department of Medical, Surgical and Health Science, University of Trieste, Trieste, Italy

    Nicola Pavan MD, PhD

  2. Department of Urology, UC San Diego Health System, La Jolla, CA, USA

    Ithaar H. Derweesh MD

  3. Department of Urology, Instituto Valenciano de Oncologia, Valencia, Spain

    Carme Maria Mir MD

  4. Department of Surgery, Oncology and Gastroenterology - Urology Clinic, University of Padua, Padua, Italy

    Giacomo Novara MD

  5. Division of Urology, Virginia Commonwealth University, Richmond, VA, USA

    Lance J. Hampton MD

  6. Department of Urology, European Institute of Oncology, Milan, Italy

    Matteo Ferro MD

  7. Department of Urology, Istituto Nazionale Tumori - IRCCS Fondazione G.Pascale, Naples, Italy

    Sisto Perdonà MD

  8. Department of Urology, Miller School of Medicine, University of Miami, Miami, FL, USA

    Dipen J. Parekh MD

  9. Division of Urology, San Luigi Hospital Orbassano, University of Torino, Torino, Italy

    Francesco Porpiglia MD

  10. Urology Institute, University Hospitals, Case Western Reserve University, Cleveland, OH, USA

    Riccardo Autorino MD, PhD

Authors
  1. Nicola Pavan MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Ithaar H. Derweesh MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Carme Maria Mir MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Giacomo Novara MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Lance J. Hampton MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Matteo Ferro MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Sisto Perdonà MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Dipen J. Parekh MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Francesco Porpiglia MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Riccardo Autorino MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Riccardo Autorino MD, PhD.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Pavan, N., Derweesh, I.H., Mir, C.M. et al. Outcomes of Laparoscopic and Robotic Partial Nephrectomy for Large (>4 Cm) Kidney Tumors: Systematic Review and Meta-Analysis. Ann Surg Oncol 24, 2420–2428 (2017). https://doi.org/10.1245/s10434-017-5831-5

Download citation

  • Received:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1245/s10434-017-5831-5

Keywords

Search

Navigation