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<p>This investigation aimed to evaluate differences in perioperative outcomes between patients with imperative versus elective indications undergoing robot-assisted partial nephrectomy (RAPN). A structured evidence synthesis was undertaken following PRISMA 2020 guidance. Electronic databases including Web of Science, PubMed, Embase, and the Cochrane Library were systematically screened up to January 2026 to retrieve comparative cohort studies examining RAPN across the two indication categories. The analyzed endpoints comprised operative time, renal warm ischemia time, intraoperative blood loss, transfusion events, postoperative complication profiles (with major complications defined as Clavien–Dindo grade ≥ 3), and surgical margin status. Study quality was appraised using the Newcastle–Ottawa assessment framework. Quantitative analyses were conducted using Review Manager (RevMan, version 5.4). The review methodology had been prospectively documented in the PROSPERO registry (CRD420261305308). Three retrospective cohort studies were included. The original cohorts comprised 4437 patients; in the study by Tan et al. [2021, BJU Int 128:30–35], propensity score–matched data (304 patients; 76 imperative vs. 228 elective) were used for pooling. The final meta-analysis included 936 patients (231 imperative and 705 elective). No significant difference was observed in operative time or estimated blood loss based on descriptive analyses of two studies. Additionally, no significant differences were found in WIT (MD − 0.30 min, 95% CI − 1.59 to 1.00, <i>P</i> = 0.65), transfusion rate (OR 1.20, 95% CI 0.65–2.20, <i>P</i> = 0.56), or PSM (OR 0.79, 95% CI 0.29–2.13, <i>P</i> = 0.64). However, patients with imperative indications were associated with a higher risk of major complications (OR 2.42, 95% CI 1.14–5.14, <i>P</i> = 0.02), while overall complication rates were similar (OR 1.18, 95% CI 0.79–1.75, <i>P</i> = 0.41). Between-study heterogeneity was generally low. RAPN appears feasible for patients with imperative indications, with perioperative measures comparable to elective cases, but a higher risk of major complications. Careful preoperative risk assessment and perioperative management are warranted, and procedures should ideally be performed in experienced centers.</p>

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Perioperative outcomes of robot-assisted partial nephrectomy in patients with imperative versus elective indications: a systematic review and meta-analysis

  • 期刊论文

  • 发表日期：

    2026年4月10日

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  • Jing-yun Yin,
  • Jiao Qin,
  • Jing Huang,
  • Hong-wu Li,
  • Song Cao,
  • Hao-tian Huang,
  • Xiao-yu Zhou,
  • Qian-long Li,
  • Hong-yuan Li,
  • Xue-song Yang

摘要

This investigation aimed to evaluate differences in perioperative outcomes between patients with imperative versus elective indications undergoing robot-assisted partial nephrectomy (RAPN). A structured evidence synthesis was undertaken following PRISMA 2020 guidance. Electronic databases including Web of Science, PubMed, Embase, and the Cochrane Library were systematically screened up to January 2026 to retrieve comparative cohort studies examining RAPN across the two indication categories. The analyzed endpoints comprised operative time, renal warm ischemia time, intraoperative blood loss, transfusion events, postoperative complication profiles (with major complications defined as Clavien–Dindo grade ≥ 3), and surgical margin status. Study quality was appraised using the Newcastle–Ottawa assessment framework. Quantitative analyses were conducted using Review Manager (RevMan, version 5.4). The review methodology had been prospectively documented in the PROSPERO registry (CRD420261305308). Three retrospective cohort studies were included. The original cohorts comprised 4437 patients; in the study by Tan et al. [2021, BJU Int 128:30–35], propensity score–matched data (304 patients; 76 imperative vs. 228 elective) were used for pooling. The final meta-analysis included 936 patients (231 imperative and 705 elective). No significant difference was observed in operative time or estimated blood loss based on descriptive analyses of two studies. Additionally, no significant differences were found in WIT (MD − 0.30 min, 95% CI − 1.59 to 1.00, P = 0.65), transfusion rate (OR 1.20, 95% CI 0.65–2.20, P = 0.56), or PSM (OR 0.79, 95% CI 0.29–2.13, P = 0.64). However, patients with imperative indications were associated with a higher risk of major complications (OR 2.42, 95% CI 1.14–5.14, P = 0.02), while overall complication rates were similar (OR 1.18, 95% CI 0.79–1.75, P = 0.41). Between-study heterogeneity was generally low. RAPN appears feasible for patients with imperative indications, with perioperative measures comparable to elective cases, but a higher risk of major complications. Careful preoperative risk assessment and perioperative management are warranted, and procedures should ideally be performed in experienced centers.