Robotic versus open partial nephrectomy in the context of mild severity complications: a meta-analysis of comparative studies supplemented by meta-regression

Abstract

Abstract Background The incidence of mild postoperative complications has been shown to be strongly associated with the beneficial effects provided through minimally invasive surgery. The main objective of the present study was to compare robotic and conventional open partial nephrectomy in terms of the incidence of mild postoperative complications. Main body The literature search process included all the comparative studies identified up to April 2022. Inclusion criteria concerned studies published in English, involving exclusively adult patients with solitary or multiple renal masses, who underwent robotic/robot-assisted or open partial nephrectomy. As mild postoperative complications, were defined those of Clavien–Dindo grade ≤ II. The meta-analysis included a total of 16 studies (3238 patients) and was also supplemented by appropriate subgroup analysis and meta-regression analysis to investigate for any additional sources of heterogeneity. Pooled data analysis revealed a statistically significant advantage with the adoption of the robotic approach (petoOR = 0.52, CI95% [0.43; 0.64]), while similar results were obtained from the analysis of the subgroups of studies with or without patient matching, those conducted in a single or multiple centers, as well as those published after 2015. From meta-regression, a time-independent superiority of robotic over open partial nephrectomy emerged, characterized by a tendency to broaden over the years. This finding was attributed to inherent features of robotic technology, the utilization of which is optimized in the context of its wider adoption in current kidney surgery practice. Short conclusion The main conclusion that can be drawn implies the clear superiority on the part of robotic partial nephrectomy over open surgery, in reducing the incidence of mild postoperative complications.