Meta-analysis Of The Clinical Efficacy Of Transperitoneal Approach And Retroperitoneal Approach Laparoscopy In The Treatment Of Renal Carcinoma

Objective:In this context,we devoted to evaluate the clinical efficiency and safety of the transperitoneal and retroperitoneal approaches in laparoscopic radical nephrectomy /partial nephrectomy for renal cancer,and to provide evidence-based medical supports for clinical treatment.Methods:From the time that built these databases to that of December 31,2017.Chinese retrieval words:(renal carcinoma)[subject terms] AND(transperitoneal OR retroperitoneal)[subject terms].English retrieval words :(laparoscopic radical/partial nephrectomy)[Title/Abstract] AND(transperitoneal OR retroperitoneal)[Title/Abstract]).The collected literature which was related to the transperitoneal and retroperitoneal approaches in laparoscopic radical nephrectomy / partial nephrectomy for renal cancer were listed in the end of the article.Retrospective study and randomized controlled trial were used to compare the preoperative and postoperative variables,surgical complication related variables in the two types of laparoscopic surgery.Results:Twelve relevant studies were collected in this study,including seven studies assessing the clinical effects of transperitoneal laparoscopic radical nephrectomy(TLRN)vs those of retroperitoneal laparoscopic radical nephrectomy(RLRN)and five studies assessing the clinical effects of transperitoneal laparoscopic partial nephrectomy(TLPN)vs those of retroperitoneal laparoscopic partial nephrectomy(RLPN).A total of patients with renal cancer was 1095.It was clear that retroperitoneal laparoscopic radical nephrectomy(RLRN)had a shorter opration time compared with transperitoneal laparoscopic radical nephrectomy(TLRN)by Meta analyze.(RE: weighted mean difference [WMD]40.08min;95% confidence interval [CI] 25.55-54.60;P=0.0006).In the overall analysis,the time of fasting water after operation was WMD 0.46 days;95%CI 0.09-1.01;P 0.10.Because of the high heterogeneity of data,a sensitivity analysis was taken for the group,and the result suggested that RLRN had a shorter time of fasting water after operation compared with TLRN(RE:WMD 0.64 days;95%CI 0.07-1.21;P=0.03).In the meanwhile,retroperitoneal laparoscopic partial nephrectomy(RLPN)had a shorter opration time(RE:WMD 28.89min;95%CI 6.62-51.17;P=0.01)and a shorter postoperative hospitalization time(RE:WMD 1.47days;95%CI 0.71-2.24;P=0.0002)compare with transperitoneal laparoscopic partial nephrectomy(TLPN).There were no significant differences between the retroperitoneal and transperitoneal approaches in other variate.Counclusions:1.This study confirmed that in laparoscopic surgery treatment of renal cell carcinoma,the time of retroperitoneal laparoscopic approach was shorter than that of transperitoneal laparoscopic approach in the operative time,after hospitalization time and the time to first oral intake after operation,and the difference was statistically significant.There were no significant differences in the amount of intraoperative bleeding,the time of intraoperative PN occlusion of the renal artery,the changes of renal function before and after PN operation time,the incidence of complications,intraoperative conversion to open or transfer radical nephrectomy and the rate of Intraoperative blood transfusion.2.This study confirmed that in the laparoscopic surgery treatment of renal cell carcinoma,especially for the tumor in the dorsal side of the renal,priority should be given to retroperitoneal approach.