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A Meta-analysis Of Retroperitoneal Laparoscopic Versus Open Radical Nephrectomy For Renal Cell Carcinoma

Posted on:2011-03-12Degree:MasterType:Thesis
Country:ChinaCandidate:X WangFull Text:PDF
GTID:2154360308474300Subject:Surgery
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Objective: The purpose of this study was to analyze the published articles of retroperitoneal laparoscopic radical nephrectomy (RLRN) compared to open radical nephrectomy (ORN) for renal cell carcinoma(RCC), to evaluate the mean operative time, mean operative blood loss, mean postoperative hospital stay, rate of postoperative analgesic, rate of tumor recurrence and mortality of two different surgical by means of the method of meta analysis , in order to provide evidence for clinical treatment of RCC.Methods: We searched the literature about RLRN versus ORN for RCC in Chinese and English from EMCC, Ovid, Splinger,Pubmed,Google Scholar and CNKI, Using the search terms"renal cell carcinoma(RCC), Laparoscopic , open, radical nephrectomy"from January 1993 to February 2010. The studies we searched should be identified according to the previously established inclusion criteria, then the studies which were selected assessed by methodological quality. Finally, date were taken from the studies using self-tabulate table and a Meta-analysis was performed in RevMan 5.0.Results: There were four RCT studies of RLRN versus ORN for RCC included in this Meta-analysis. A total of 531 patients from four studies were included, of which RLRN group 275 and ORN group 256. Age composition and size of the tumors were similar. In the Meta-analysis of these studies, the mean operative time was similar p=0.69. Mean operative blood loss was less in RLRN group than in ORN group with random effects model, weighted mean difference -82.14, 95%CI(-110.91,-53.37),P<0.0001, and it has statistical significance. Mean postoperative hospital stay was shorter in RLRN group than in ORN group with fixed effects model, weighted mean difference -4.35, 95%CI(-4.62,-4.08),P<0.0001. Rate of postoperative analgesic was lower in RLRN group than in ORN group with fixed effects model, OR=0.01,95%CI(0.01,0.03),P<0.0001.The comparison of RLRN and ORN, rate of tumor recurrence OR=3.11,95%CI(0.12,79.43),P=0.94, and rate of tumor mortality OR=0.32,95%CI(0.01,8.24), P=0.49, which means that there were no statistical difference between the two groups.Conclusion: The results of this Meta-analysis suggest that there were no statistical difference in mean operative time, rate of tumor recurrence and mortality between RLRN versus ORN for RCC, but RLRN had less operative blood loss, shorter postoperative and lower rate of postoperative analgesic and can be widely used. However, because the statistic quality of most of chosen studies is comparably low and the quantity is very few, more and higher randomized clinical trial are demanded to further evaluate and prove the effect of RLRN.
Keywords/Search Tags:renal cell carcinoma(RCC), Laparoscopic, open, radical nephrectomy, Meta-analysis
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