Comparison of perioperative outcomes of robotic vs. laparoscopic partial nephrectomy for renal tumors with a RENAL nephrometry score ≥7: A meta-analysis.

Introduction: To compare the perioperative outcomes of robotic partial nephrectomy (RPN) vs. laparoscopic partial nephrectomy (LPN) for complex renal tumors with a RENAL nephrometry score ≥7. Methods: We searched PubMed, EMBASE and the Cochrane Central Register for studies from 2000 to 2020 to evaluate the perioperative outcomes of RPN and LPN in patients with a RENAL nephrometry score ≥7. We used RevMan 5.2 to pool the data. Results: Seven studies were acquired in our study. No significant differences were found in the estimated blood loss (WMD: 34.49; 95% CI: -75.16-144.14; p = 0.54), hospital stay (WMD: -0.59; 95% CI: -1.24-0.06; p = 0.07), positive surgical margin (OR: 0.85; 95% CI: 0.65-1.11; p = 0.23), major postoperative complications (OR: 0.90; 95% CI: 0.52-1.54; p = 0.69) and transfusion (OR: 0.72; 95% CI: 0.48-1.08; p = 0.11) between the groups. RPN showed better outcomes in the operating time (WMD: -22.45; 95% CI: -35.06 to -9.85; p = 0.0005), postoperative renal function (WMD: 3.32; 95% CI: 0.73-5.91; p = 0.01), warm ischemia time (WMD: -6.96; 95% CI: -7.30--6.62; p < 0.0001), conversion rate to radical nephrectomy (OR: 0.34; 95% CI: 0.17 to 0.66; p = 0.002) and intraoperative complications (OR: 0.52; 95% CI: 0.28-0.97; p = 0.04). Discussion: RPN is a safe and effective alternative to LPNs for or the treatment of complex renal tumors with a RENAL nephrometry score ≥7 with a shorter warm ischemic time and better postoperative renal function.

Cause of Death During Renal Cell Carcinoma Survivorship: A Contemporary, Population-Based Analysis.

Background: As the survival rates of patients with renal cell carcinoma (RCC) continue to increase, noncancer causes of death cannot be ignored. The cause-specific mortality in patients with RCC is not well understood. Objective: Our study aimed to explore the mortality patterns of contemporary RCC survivors. Methods: We performed a retrospective cohort study involving patients with RCC from the Surveillance, Epidemiology, and End Results (SEER) database. We used standardized mortality ratios (SMRs) to compare the death rates in patients with RCC with those in the general population. Results: A total of 106,118 patients with RCC, including 39,630 who died (27%), were included in our study. Overall, compared with the general US population, noncancer SMRs were increased 1.25-fold (95% confidence intervals [CI], 1.22 to 1.27; observed, 11,235), 1.19-fold (95% CI, 1.14 to 1.24; observed, 2,014), and 2.24-fold (95% CI, 2.11 to 2.38; observed, 1,110) for stage I/II, III, and IV RCC, respectively. The proportion of noncancer causes of death increased with the extension of survival time. A total of 4,273 men with stage I/II disease (23.13%) died of RCC; however, patients who died from other causes were 3.2 times more likely to die from RCC (n = 14,203 [76.87%]). Heart disease was the most common noncancer cause of death (n = 3,718 [20.12%]; SMR, 1.23; 95% CI, 1.19-1.27). In patients with stage III disease, 3,912 (25.98%) died from RCC, and 2,014 (13.37%) died from noncancer causes. Most patients (94.99%) with stage IV RCC died within 5 years of initial diagnosis. Although RCC was the leading cause of death (n = 12,310 [84.65%]), patients with stage IV RCC also had a higher risk of noncancer death than the general population (2.24; 95% CI, 2.11-2.38). Conclusions: Non-RCC death causes account for more than 3/4 of RCC survivors among patients with stage I/II disease. Patients with stage IV are most likely to die of RCC; however, there is an increased risk of dying from septicemia, and suicide cannot be ignored. These data provide the latest and most comprehensive assessment of the causes of death in patients with RCC.

HPLC fingerprinting-based multivariate analysis of chemical components in Tetrastigma Hemsleyanum Diels et Gilg: Correlation to their antioxidant and neuraminidase inhibition activities.

Tetrastigma Hemsleyanum Diels & Gilg (TDG) has attracted growing attention in China; however, there were few studies on its bioactive components. Herein, the characteristic chemical components and dual antioxidant and neuraminidase inhibitory activities of fifteen batches of TDG from different places of origin and their relevance were investigated. The HPLC fingerprint was first established and the marker components were identified by using UPLC-Q-TOF-MS/MS. Catechin-5-O-ß-d-glucopyranoside, tartaric acid, (1R, 2R, 4S)-2-hydroxy-1, 8-cineole-ß-d-glucopyranoside, and phlorizin were identified for the first time. The result of multivariate statistical analysis indicated that multiple components have a significant contribution to the classification of TDG, such as chlorogenic acid, saccharumoside C/D, robinin, procyanidin B2, rutin, isoquercitrin, etc. Then, the antioxidant and neuraminidase inhibitory activities of fifteen batches of TDG were measured. The result of grey relationship analysis showed that the contents of rutin, isoquercitrin, kaempferol-3-rutinoside, and astragalin were positively correlated with these two activities with correlation coefficients more than 0.8. The quantitative analysis of these four bioactive compounds was performed by using HPLC-DAD. The recovery rate of the method varied from 98.02% to 100.21%, the RSD values of precision, stability and repeatability were between 1.32-3.15 %, and the R value of the linear equation was above 0.9990. To sum up, this study is valuable in the quality control of TDG.

Comparison of Retzius-sparing robot-assisted laparoscopic radical prostatectomy vs standard robot-assisted radical prostatectomy: a meta-analysis.

BACKGROUND: To compare the postoperative continence and clinical outcomes of Retzius-sparing robot-assisted laparoscopic radical prostatectomy (RS-RALP) with non-RS RALP for patients with prostate cancer. METHODS: We searched PUBMED, EMBASE and the Cochrane Central Register from 1999 to 2019 for studies comparing RS-RALP to non-RS RALP for the treatment of prostate cancer. We used RevMan 5.2 to pool the data. RESULTS: A total of seven studies involving 1620 patients were included in our meta-analysis. No significant difference was found in positive surgical margins (PSM), bilateral nerve-sparing, postoperative hernia, complications, blood loss, or operative time. Postoperative continence was better with RS-RALP compared with non-RS RALP (OR = 1.02, OR: 2.86, 95% CI 1.94-4.20, p < 0.05). CONCLUSIONS: RS-RALP had a better recovery of postoperative continence than non-RS RALP. The perioperative outcomes were comparable for the two methods.

Comparison of the retroperitoneal versus Transperitoneal laparoscopic Adrenalectomy perioperative outcomes and safety for Pheochromocytoma: a meta-analysis.

BACKGROUND: To compare the perioperative outcomes and safety of transperitoneal laparoscopic adrenalectomy with those of retroperitoneal laparoscopic adrenalectomy for patients with pheochromocytoma. METHODS: We searched PubMed, EMBASE and the Cochrane Central Register for studies from 1999 to 2019 to assess the perioperative outcomes and safety of transperitoneal laparoscopic adrenalectomy and the retroperitoneal approach for laparoscopic adrenalectomy in patients with pheochromocytoma. After data extraction and quality assessments, we used RevMan 5.2 to pool the data. RESULTS: Four retrospective studies were obtained in our meta-analysis. Patients who underwent retroperitoneal laparoscopic adrenalectomy were associated with shorter operative time (WMD: 34.91, 95% CI: 27.02 to 42.80, I2 = 15%; p < 0.01), less intraoperative blood loss (WMD: 139.32, 95% CI: 125.38 to 153.26, I2 = 0, p < 0.01), and a shorter hospital stay (WMD: 2, 95% CI: 1.18 to 2.82, I2 = 82%, p < 0.01) than patients who underwent transperitoneal laparoscopic adrenalectomy. No significant differences were found in the complication rate (OR: 1.58, 95% CI: 0.58 to 4.33, I2 = 0; p = 0.38) or in the incidence of hemodynamic crisis (OR: 0.74, 95% CI: 0.19 to 2.94, p = 0.67) between the two groups. CONCLUSION: Retroperitoneal laparoscopic adrenalectomy could achieve better perioperative outcomes than the transperitoneal approach for patients with pheochromocytoma.

Comparison of overall survival and perioperative outcomes of laparoscopic pancreaticoduodenectomy and open pancreaticoduodenectomy for pancreatic ductal adenocarcinoma: a systematic review and meta-analysis.

BACKGROUND: The aim of this study was to compare the oncological outcomes and clinical efficacy of laparoscopic pancreaticoduodenectomy (LPD) and open pancreaticoduodenectomy (OPD) in patients with pancreatic ductal adenocarcinoma (PDAC). METHODS: We systematically searched PubMed, EMBASE, Web of Science, ClinicalTrials.gov and the Cochrane Central Register for studies published between May 1998 and May 2018. The included studies compared LPD and OPD for the treatment of PDAC. The oncological outcomes and perioperative data were analyzed. RESULTS: Eight studies involving 15,278 patients were included in our meta-analysis. No significant difference was found in the 5-year overall survival (OS) between patients undergoing the two types of surgery (HR: 0.97, 95% CI 0.82-1.15, p = 0.76). LPD resulted in a higher rate of R0 resection than OPD (OR: 1.16, 95% CI 0.85-1.57, p > 0.05). This study showed that compared with OPD, LPD resulted in comparable rates of postoperative pancreatic fistulas (POPFs) (OR: 1.07, 95% CI: 0.68-1.68, p = 0.77) and postoperative hemorrhage (OR: 1.74, 95% CI 0.96-3.71, p = 0.07), more harvested lymph nodes (WMD: 1.84, 95% CI: 0.95-2.72, p < 0.05), shorter hospital stays (WMD: -2.45, 95% CI: - 3.33- -1.56, p < 0.05), and less estimated blood loss (WMD: -374.30, 95% CI: - 513.06- -235.54, p < 0.05). CONCLUSIONS: LPD is equivalent to OPD with respect to 5-year OS and results in better perioperative clinical outcomes for patients with PDAC.

Comparison of the long-term follow-up and perioperative outcomes of partial nephrectomy and radical nephrectomy for 4 cm to 7 cm renal cell carcinoma: a systematic review and meta-analysis.

BACKGROUND: The efficacy of partial nephrectomy (PN) for T1b renal cell carcinoma (RCC) is controversial. The oncological outcomes, the change in postoperative renal function and the perioperative complications are unclear. METHODS: We searched PUBMED, EMBASE and the Cochrane Central Register for studies from March 1998 to March 2018 for studies comparing PN to radical nephrectomy (RN) for the treatment of T1b RCC. After data extraction and quality assessment, we used RevMan 5.2 to pool the data. Then, we used Stata 12.0 to perform sensitivity analyses and meta-regression. We used the GRADE profiler to evaluate the evidence according to the GRADE approach. RESULTS: A total of 16 studies involving 33,117 patients were included in our meta-analysis. No significant difference was found in the 5-year overall survival (OS), 10-year OS, 5-year recurrence-free survival (RFS) and 10-year RFS. The 5-year cancer-special survival (CSS) and 10-year CSS were better in RN compared to PN, respectively, at RR = 1.02, P < 0.05 and RR = 1.04, P < 0.05. PN was better than RN in the preservation of renal function (WMD = -9.15, 95% CI: - 10.30 to - 7.99, P < 0.05). The confidence level grading of the evidence was moderate for 5-year OS, 10-year OS, 5-year CSS, 10-year CSS, 5-year RFS, 10-year RFS, tumor recurrence, decline in eGFR, and postoperative complications. CONCLUSIONS: PN may provide comparable outcomes in terms of RFS & OS, and better renal function preservation although CSS was worse.

Transurethral resection of the prostate versus prostatic artery embolization in the treatment of benign prostatic hyperplasia: a meta-analysis.

BACKGROUND: To compare the clinical efficiency and safety of transurethral resection of the prostate (TURP) and prostatic artery embolization (PAE) for the treatment of Benign prostatic hyperplasia (BPH). METHODS: We searched PUBMED, EMBASE and the Cochrane Central Register for studies from May 1998 to May 2018 for studies comparing the efficiency and safety of TURP with PAE. Four studies met the inclusion criteria for our meta-analysis. After data extraction and quality assessment, we used RevMan 5.2 to pool the data. RESULTS: A total of four studies involving 506 patients were included in our meta-analysis. The pooled data showed that the Qmax was higher in TURP group than PAE with a significant difference (WMD:4.66, 95%CI 2.54 to 6.79, P < 0.05). The postoperative QOL was lower in the TURP than PAE group (WMD: -0.53, 95%CI -0.88 to - 0.18, P < 0.05). The postoperative prostate volume was significantly smaller in the TURP than PAE group (WMD: -8.26, 95%CI -12.64 to - 3.88, P < 0.05). The operative time was significantly shorter in the TURP than PAE group (WMD: -10.55, 95%CI -16.92 to - 4.18, P < 0.05). No significant difference was found in the postoperative IPSS and complications between TURP and PAE (P > 0.05, WMD:1.56, 95%CI -0.67 to 3.78, p = 0,05, OR:1.54, 95%CI 1.00 to2.38, respectively). CONCLUSIONS: TURP could achieve improved Qmax and QoL compared to PAE. Therefore, for patients with BPH and lower urinary tract symptoms (LUTS), TURP was superior to PAE.