Abstract:

BACKGROUND: It remains controversial in term of the efficacy and safety for the two approaches laparoscopic surgery for treatment of localised renal cell carcinoma limited its further investigation.
OBJECTIVE: To assess the difference of clinical outcomes in the comparative studies evaluating transperitoneal and retroperitoneal approaches for radical nephrectomy.
METHODS: A systematic review of the literature was performed in January 2010, searching Medline, Embase, Cochrane Library, CBM, and CNKI from January 1966 to December 2009. A “random, semi-randomized controlled study of literature” protocol using the term laparoscopic radical nephrectomy was applied. The authors reviewed the records to identify comparative studies. A cumulative analysis was conducted using Review Manager software v.4.2.
RESULTS AND CONCLUSION: We identified 5 prospective randomized controlled studies, meta analysis results showed that, there was no significant difference between transperitoneal laparoscopic radical nephrectomy and retroperitioneoscopic laparoscopic radical nephrectomy in estimated blood loss [SMD=-0.22, 95%CI(-0.52, 0.09)] and specimen weight [SMD=0.35, 95%CI (-0.17, 0.86)], significant difference was existed in operative time [SMD=0.72, 95%CI(0.41, 1.03)] and complication rate [OR=2.16, 95%CI(1.03, 4.51)]. The available data were not sufficient to prove the superiority of any surgical approach in terms of estimated blood loss and specimen weight. Retroperitioneoscopic laparoscopic radical nephrectomy is followed by significantly lower operative time, and complication than transperitoneal laparoscopic radical nephrectomy.