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

Objective: 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. Methods: MEDLINE, EMBASE and the Cochrane Library were searched acco...

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Autores principales:	Thomas Stonier, Nick Simson, Su-Min Lee, Ian Robertson, Tarik Amer, Bhaskar K. Somani, Bhavan P. Rai, Omar Aboumarzouk
Formato:	article
Lenguaje:	EN
Publicado:	Taylor & Francis Group 2017
Materias:	Nephroureterectomy Robotic Laparoscopic Ureteric neoplasm ureter Diseases of the genitourinary system. Urology RC870-923
Acceso en línea:	https://doaj.org/article/eafbca21575d40e39091bdffc3909ac3
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spelling	oai:doaj.org-article:eafbca21575d40e39091bdffc3909ac32021-12-02T09:51:22ZLaparoscopic vs robotic nephroureterectomy: Is it time to re-establish the standard? Evidence from a systematic review2090-598X10.1016/j.aju.2017.05.002https://doaj.org/article/eafbca21575d40e39091bdffc3909ac32017-09-01T00:00:00Zhttp://www.sciencedirect.com/science/article/pii/S2090598X17300670https://doaj.org/toc/2090-598XObjective: 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. Methods: 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. Results: 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 251 min, P = 0.03; 306 vs 234 min, 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). Conclusions: 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.Thomas StonierNick SimsonSu-Min LeeIan RobertsonTarik AmerBhaskar K. SomaniBhavan P. RaiOmar AboumarzoukTaylor & Francis GrouparticleNephroureterectomyRoboticLaparoscopicUreteric neoplasm ureterDiseases of the genitourinary system. UrologyRC870-923ENArab Journal of Urology, Vol 15, Iss 3, Pp 177-186 (2017)
institution	DOAJ
collection	DOAJ
language	EN
topic	Nephroureterectomy Robotic Laparoscopic Ureteric neoplasm ureter Diseases of the genitourinary system. Urology RC870-923
spellingShingle	Nephroureterectomy Robotic Laparoscopic Ureteric neoplasm ureter Diseases of the genitourinary system. Urology RC870-923 Thomas Stonier Nick Simson Su-Min Lee Ian Robertson Tarik Amer Bhaskar K. Somani Bhavan P. Rai Omar Aboumarzouk Laparoscopic vs robotic nephroureterectomy: Is it time to re-establish the standard? Evidence from a systematic review
description	Objective: 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. Methods: 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. Results: 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 251 min, P = 0.03; 306 vs 234 min, 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). Conclusions: 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.
format	article
author	Thomas Stonier Nick Simson Su-Min Lee Ian Robertson Tarik Amer Bhaskar K. Somani Bhavan P. Rai Omar Aboumarzouk
author_facet	Thomas Stonier Nick Simson Su-Min Lee Ian Robertson Tarik Amer Bhaskar K. Somani Bhavan P. Rai Omar Aboumarzouk
author_sort	Thomas Stonier
title	Laparoscopic vs robotic nephroureterectomy: Is it time to re-establish the standard? Evidence from a systematic review
title_short	Laparoscopic vs robotic nephroureterectomy: Is it time to re-establish the standard? Evidence from a systematic review
title_full	Laparoscopic vs robotic nephroureterectomy: Is it time to re-establish the standard? Evidence from a systematic review
title_fullStr	Laparoscopic vs robotic nephroureterectomy: Is it time to re-establish the standard? Evidence from a systematic review
title_full_unstemmed	Laparoscopic vs robotic nephroureterectomy: Is it time to re-establish the standard? Evidence from a systematic review
title_sort	laparoscopic vs robotic nephroureterectomy: is it time to re-establish the standard? evidence from a systematic review
publisher	Taylor & Francis Group
publishDate	2017
url	https://doaj.org/article/eafbca21575d40e39091bdffc3909ac3
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Laparoscopic vs robotic nephroureterectomy: Is it time to re-establish the standard? Evidence from a systematic review

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