Comparative investigation of therapeutic efficacy in tumor resection between robotic and open partial nephrectomy: A meta-analysis supplemented by time-series and quality-based meta-regression

Background: Differential tumor resection efficacy between robotic and open partial nephrectomy has been extensively explored. This study comparatively evaluates the above nephron-sparing approaches focusing on the Trifecta outcome, along with its individual components, as a metric for surgical quality assessment. Methods: A literature review from August 2022 to August 2024 yielded 51 relevant studies. Trifecta attainment served as the primary outcome, while secondary end-points included the incidence of major and minor postoperative complications, positive surgical margin rates, the absolute ischemia duration, as well as the corresponding postoperative alterations in estimated glomerular filtration rate and plasma creatinine levels. Analyses were conducted using random-effects meta-analysis models, with subgroup analyses performed to manage heterogeneity. Additionally, meta-regression was implemented on a temporal and qualitative basis, and sensitivity analysis was carried out on the most statistically robust studies. Results: The robotic approach exhibited clear superiority in overall Trifecta achievement, with odds ratios ranging between 1.3-1.8 and indicating a quasi-constant comparative effect over time. Major and minor complication rates, as defined by the Clavien-Dindo classification, favored robotic surgery, demonstrating odds ratios of 0.5-0.7 and 0.5-0.6, respectively. Specifically, a consistent to increasing trend of advantage was observed for severe complications over time and across qualitative measures. Conversely, a stable and significant benefit was noted for mild complications on the chronological scale. The robotic intervention also significantly impacted the estimated glomerular filtration rate, preserving an additional 2-3 ml/min/1.73m ² postoperatively compared to open surgery. However, this finding was considered of limited clinical importance due to the low magnitude of the effect. Ischemic times and positive surgical margin rates did not significantly differ between the two approaches. Finally, the findings regarding the postoperative increase in serum creatinine levels from baseline were inconclusive, with neither modality demonstrating superiority over the other. Conclusion: Robotic partial nephrectomy surpasses open surgery in Trifecta attainment and in mitigating major and minor complications. However, the clinical significance of renal function preservation is marginal and requires further prospective investigation.