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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.
RESUMEN
Background: Very few studies have been published on the causes of death of upper tract urothelial carcinoma (UTUC). We sought to explore the mortality patterns of contemporary UTUC survivors. Methods: We performed a retrospective cohort study involving patients with upper urinary tract carcinoma from the National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER) database (2000 and 2015). We used standardized mortality ratios (SMRs) to compare death rates among patients with UTUC in the general population and excess absolute risks (EARs) to quantify the disease-specific death burden. Results: A total of 10,179 patients with UTUC, including 7,133 who died, were included in our study. In total, 302 (17.17%) patients with the localized disease died of UTUC; however, patients who died from other causes were 4.8 times more likely to die from UTUC (n = 1,457 [82.83%]). Cardiovascular disease was the most common non-cancer cause of death (n = 393 [22.34% of all deaths]); SMR, 1.22; 95% confidence intervals [CI], 1.1-1.35; EAR, 35.96). A total of 4,046 (69.99%) patients with regional stage died within their follow-up, 1,413 (34.92%) of whom died from UTUC and 1,082 (26.74%) of whom died from non-cancer causes. UTUC was the main cause of death (SMR, 242.48; 95% CI, 230-255.47; EAR, 542.47), followed by non-tumor causes (SMR, 1.18; 95% CI, 1.11-1.25; EAR, 63.74). Most patients (94.94%) with distant stage died within 3 years of initial diagnosis. Although UTUC was the leading cause of death (n = 721 [54.29%]), these patients also had a higher risk of death from non-cancer than the general population (SMR, 2.08; 95% CI, 1.67-2.56; EAR, 288.26). Conclusions: Non-UTUC deaths accounted for 82.48% of UTUC survivors among those with localized disease. Patients with regional/distant stages were most likely to die of UTUC; however, there is an increased risk of dying from non-cancer causes that cannot be ignored. These data provide the latest and most comprehensive assessment of the causes of death in patients with UTUC.