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Updated: Mar 6, 2026
Robot-Assisted Kidney Transplantation
Published on: July 19, 2021
Outcomes of Laparoscopic and Robotic Partial Nephrectomy for Large (>4 Cm) Kidney Tumors: Systematic Review and
Nicola Pavan1, Ithaar H Derweesh2, Carme Maria Mir3
1Urology Clinic, Department of Medical, Surgical and Health Science, University of Trieste, Trieste, Italy.
Purpose:
The aim of this study was to assess the outcomes of minimally invasive (laparoscopic and robotic) partial nephrectomy (MIPN) for large renal masses.
Materials And Methods:
A systematic literature review was performed up to September 2016 using multiple search engines to identify studies comparing MIPN for tumors larger than 4 cm (>cT1a) with MIPN for tumors smaller than 4 cm (cT1a). The preferred reporting items for systematic reviews and meta-analyses (PRISMA) criteria were used for article selection. Baseline demographics and surgical, functional, and oncological parameters were extracted from the included studies whenever available. An overall analysis including all studies was performed, then sensitivity analyses were performed for studies on laparoscopic partial nephrectomy (PN) only, and, finally, for studies on robotic PN only.
Results:
Overall, 13 case-control studies comparing the outcomes of PN in tumors <4 cm (n = 4441) with those of PN for tumors >4 cm (n = 1024) were included. Warm ischemia time was shorter for the <4 cm group [weighted mean difference (WMD) 3.75 min; 95% confidence interval (CI) -6.4 to -0.7; p = 0.01] and the odds of perioperative complications was lower [odds ratio (OR) 0.62; 95% CI 0.5-0.8; p < 0.001]. There were no significant differences in terms of postoperative estimated glomerular filtration rate (WMD 4.2 ml/min; 95% CI 0.45-8.97; p = 0.08), as well as onset of postoperative chronic kidney disease (risk ratio 0.71; 95% CI 0.48-1.04; p = 0.08). In addition, no difference was found in the likelihood of positive surgical margins (OR 0.74; 95% CI 0.43-1.28; p = 0.29).
Conclusions:
MIPN represents a viable treatment option for renal masses larger than 4 cm (higher than cT1a) as it offers good functional outcomes, without increased risk of positive surgical margins. An increased rate of complications should be taken into account when approaching these tumors.
Insights
Minimally invasive partial nephrectomy (MIPN) is effective for large renal masses (>4 cm), offering good functional outcomes without increasing positive surgical margins. However, surgeons should anticipate a higher rate of complications with larger tumors.
Area of Science:
- Urology
- Surgical Oncology
- Nephrology
Background:
- Renal masses larger than 4 cm present unique surgical challenges.
- Minimally invasive partial nephrectomy (MIPN) has become a standard treatment for renal tumors.
- Assessing the safety and efficacy of MIPN for larger renal masses is crucial.
Purpose of the Study:
- To evaluate the outcomes of minimally invasive (laparoscopic and robotic) partial nephrectomy (MIPN) for large renal masses (>4 cm).
- To compare MIPN outcomes for tumors >4 cm versus tumors <4 cm.
Main Methods:
- A systematic literature review was conducted using PRISMA criteria.
- Studies comparing MIPN for tumors >4 cm with MIPN for tumors <4 cm were identified.
- Surgical, functional, and oncological parameters were extracted and analyzed.
Main Results:
- Analysis of 13 studies (4441 tumors <4 cm, 1024 tumors >4 cm) revealed shorter warm ischemia time and fewer perioperative complications for smaller tumors.
- No significant differences were observed in postoperative kidney function (eGFR, CKD onset) or positive surgical margins between the groups.
- Sensitivity analyses were performed for laparoscopic and robotic partial nephrectomy separately.
Conclusions:
- MIPN is a viable option for renal masses larger than 4 cm, providing good functional outcomes and no increased risk of positive surgical margins.
- An increased rate of perioperative complications should be considered when performing MIPN for larger renal masses.
