Robot-assisted partial nephrectomy for hilar versus non-hilar renal tumors: a systematic review and meta-analysis

We conducted this comprehensive systematic review and meta-analysis to assess surgical outcomes, kidney function preservation, and cancer control efficacy when comparing robot-assisted partial nephrectomy (RAPN) outcomes between renal hilar masses and peripherally located tumors. We performed an exhaustive search strategy utilizing four major electronic databases to capture all relevant comparative investigations published up to August 2025. Meta-analytical calculations were executed through Review Manager (RevMan) version 5.4 software platform. Our investigation synthesized data from eight research studies, including 7064 participants (1292 presenting hilar masses, 5772 with peripheral lesions). Comparative analysis revealed that RAPN procedures for hilar lesions demonstrated significantly longer surgical duration (WMD 22.18 min, 95% CI 16.86 to 27.51; p < 0.00001), greater intraoperative hemorrhage (WMD 31.66 ml, 95% CI 10.10 to 53.21; p = 0.004), higher blood transfusion requirements (OR 1.68, 95% CI 1.14 to 2.49; p = 0.009), prolonged renal clamping duration (WMD 4.89 min, 95% CI 2.80 to 6.97; p < 0.00001), increased severe adverse events (OR 1.44, 95% CI 1.03 to 2.01; p = 0.03), and diminished probability of optimal surgical outcomes (OR 0.45, 95% CI 0.25 to 0.84; p = 0.01). However, both patient cohorts exhibited equivalent outcomes regarding hospitalization duration, total adverse events, surgical approach conversion frequencies to open procedures or radical nephrectomy, postoperative kidney function deterioration, positive surgical margin (PSM), and tumor recurrence patterns, showing no statistically meaningful disparities. While technically more demanding and associated with increased perioperative morbidity, RAPN for hilar tumors is a safe and effective procedure that provides crucial renal functional and oncological outcomes comparable to those of RAPN for non-hilar tumors.