Robotic Versus Open Partial Nephrectomy For Complex Renal Tumors: A systematic review and meta-analysis

Background: The management of complex renal tumors presents a significant surgical challenge, with open partial nephrectomy (OPN) being the historical gold standard. The adoption of robot-assisted partial nephrectomy (RPN) has expanded, but its role in complex cases requires rigorous evaluation. Objective: To systematically review and meta-analyze the evidence from high-quality comparative studies, including the first randomized controlled trial (RCT), to compare the perioperative, functional, and oncological outcomes of RPN versus OPN for complex renal tumors. Methods: Following the PRISMA guidelines, a systematic search was conducted in PubMed/MEDLINE, Scopus, Web of Science, and LILACS databases up to March 2024. An RCT and propensity-score-matched (PSM) cohort studies comparing RPN and OPN for complex tumors (defined by high nephrometry scores or large size) were included. A random-effects model was used to pool data. Results: Five studies (one RCT, four PSM cohorts) totaling 723 patients (409 RPN, 314 OPN) were included. The pooled analysis showed that RPN was associated with significantly less estimated blood loss (Mean Difference [MD]: -143.9 mL; 95% CI: -220.1 to -67.7) and shorter length of stay (MD: -1.8 days; 95% CI: -2.4 to -1.2). There was no significant difference in warm ischemia time, major complications (Odds Ratio [OR]: 0.61; 95% CI: 0.41 to 0.90; I²=0%), or positive surgical margins (OR: 0.50; 95% CI: 0.15 to 1.63; I²=0%). Conclusion: For complex renal tumors, RPN is a safe and effective alternative to OPN, offering significant advantages in terms of reduced blood loss and faster postoperative recovery without compromising oncological control or increasing major complications.