Impact of Host Factors on Robotic Partial Nephrectomy Outcomes: Comprehensive Systematic Review and Meta-Analysis

Area of Science:

• Urology
• Surgical Oncology
• Robotic Surgery

Background:

• Robotic partial nephrectomy (RPN) is a standard treatment for kidney tumors.
• Patient and tumor characteristics (host factors) can influence RPN outcomes.
• A comprehensive evaluation of these factors is needed to optimize surgical planning and patient selection.

Purpose of the Study:

• To systematically review and meta-analyze the impact of host factors on RPN outcomes.
• To critically evaluate operative, perioperative, functional, oncologic, and survival results.
• To provide objective data for informed decision-making in RPN.

Main Methods:

• Systematic review and meta-analysis of 41 English-language studies (2000-2017).
• Inclusion of 10,506 patients from PubMed, Scopus, and Web of Science databases.
• Analysis using PRISMA and AHRQ guidelines, with weighted mean difference and odds ratios.

Main Results:

• Complex and large tumors (>4 cm) are associated with longer operative times, increased blood loss, warm ischemia time, and complications.
• Hilar tumors increase blood loss, warm ischemia time, and conversion rates.
• Obesity and chronic kidney disease impact operative time, blood loss, and complication rates, while CKD may improve functional outcomes.

Conclusions:

• Host factors, including tumor characteristics and patient comorbidities, significantly influence RPN outcomes.
• Awareness of these risks and expert patient selection are crucial for successful RPN.
• This meta-analysis offers comprehensive data to guide urologists and patients considering RPN.