Robot-assisted versus laparoscopic radical nephrectomy for renal tumors in adults: A systematic review and meta-analysis.

Abstract

e16503 Background: Minimally invasive radical nephrectomy is the standard treatment for renal tumor resection. While laparoscopic radical nephrectomy (LRN) is well established, robot-assisted radical nephrectomy (RARN) has gained popularity, yet its comparative clinical benefits remain debated. This systematic review and meta-analysis compared perioperative and oncologic outcomes between RARN and LRN. Methods: A comprehensive literature search of major databases was performed to identify comparative studies evaluating RARN versus LRN for renal cancers. Outcomes analyzed included operative time, estimated blood loss, length of hospital stay, perioperative complications, blood transfusion, mortality, readmission, infection, conversion to open surgery, and cancer recurrence. Pooled effect estimates were calculated using random-effects models and reported as mean differences (MD) or odds ratios (OR) with 95% confidence intervals (CI). Results: Thirteen studies encompassing 136,766 patients were included (RARN: 51,667; LRN: 85,099).Compared with LRN, RARN was associated with significantly longer operative time (MD 30.80 minutes; 95% CI 13.14 to 48.46). No significant differences were observed in estimated blood loss (MD 27.21 mL; 95% CI -9.67 to 64.09), length of hospital stay (MD -0.41 days; 95% CI -1.17 to 0.34), overall complications (OR 0.93; 95% CI 0.78–1.11), infection (OR 0.89; 95% CI 0.53–1.48), or conversion to open surgery (OR 0.97; 95% CI 0.23–4.05). RARN was associated with higher odds of blood transfusion (OR 1.15; 95% CI 1.04–1.27) but lower odds of mortality (OR 0.59; 95% CI 0.40–0.87) and readmission (OR 0.44; 95% CI 0.22–0.87). Recurrence was more frequent following RARN (OR 1.92; 95% CI 1.09–3.36). Conclusions: Robot-assisted radical nephrectomy yields outcomes largely comparable to laparoscopy. While associated with lower mortality and readmission, these benefits are offset by longer operative time, higher transfusion rates, and increased recurrence. Laparoscopic radical nephrectomy therefore remains a reliable standard, with robotic use best reserved for selected patients until stronger prospective evidence is available. The role of robotic surgery should be individualized, and future well-designed prospective studies are essential to clarify which patients get meaningful oncologic benefit from a robotic approach.