Journal Article

Laparoscopic Nephrectomy versus Open Nephrectomy for Patients with Autosomal Dominant Polycystic Kidney Disease: A Systematic Review and Meta-Analysis

Guo, Pengyu, Ren, Minghua, Ni, Shaobin, Ren, Tong, Xu, Wanhai, Li, Huibo

2015

Overview

To compare efficacy and safety of laparoscopicnephrectomy (LN) versus open nephrectomy (ON) in the management of autosomal dominant polycystic kidney disease (ADPKD), we conducted a systematic review and meta-analysis. A systematic search of the electronic databases PubMed, Scopus, and the Cochrane Library was performed up to October 2014. This systematic review was performed based on observational comparative studies that assessed the two techniques. The weighted mean difference (WMD) and risk ratio (RR), with their corresponding 95% confidence interval (CI), were calculated to compare continuous and dichotomous variables, respectively. Seven studies were identified, including 195 cases (118 LN/77 ON). Although LN was associated with longer operative time (WMD 30.236, 95%CI 14.541 -45.932, P<0.001) and the specimen might not have been resected as heavy as the ON group (WMD -986.516, 95%CI -1883.24--89.795, P = 0.031), patients in this group might benefit from a shorter length of hospital stay (WMD -3.576, 95%CI 4.976--2.176, P <0.001), less estimated blood loss (WMD -180.245, 95%CI -317.939--42.556, P = 0.010), and lower need of transfusion (RR 0.345, 95%CI 0.183-0.650, P = 0.001). The LN group also had less overall complications (RR 0.545, 95%CI 0.329-0.903, P = 0.018). The need of narcotic analgesics between the two groups might have no significant difference (WMD -54.66, 95%CI -129.76-20.44, P = 0.154). LN for giant symptomatic ADPKD was feasible, safe and efficacious. Morbidity was significantly reduced compared with the open approach. For an experienced laparoscopist, LN might be a better alternative.

• Publisher: Public Library of Science,Public Library of Science (PLoS)
• Subject: Analgesics / Aneurysms / Blood Loss, Surgical / Blood Transfusion / Blood transfusions / Care and treatment / Comparative analysis / Comparative studies / Complications / Confidence intervals / Continuity (mathematics) / Cysts / Disease control / Hospitals / Humans / Kidney diseases / Kidneys / Laparoscopy / Laparoscopy - adverse effects / Laparoscopy - methods / Meta-analysis / Morbidity / Mortality / Nephrectomy / Nephrectomy - adverse effects / Nephrectomy - methods / Operative Time / Pain / Patients / Polycystic kidney / Polycystic kidney disease / Polycystic Kidney, Autosomal Dominant - complications / Polycystic Kidney, Autosomal Dominant - surgery / Postoperative Complications / Studies / Surgery / Systematic review / Transfusion / Treatment Outcome / Weapons of mass destruction