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

<div><p>Objective</p><p>To compare efficacy and safety of laparoscopicnephrectomy (LN) versusopen nephrectomy (ON) in the management of autosomal dominant polycystic kidney disease (ADPKD), we conducted a systematic review and meta-analysis.</p><p>Methods</p><p>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.</p><p>Results</p><p>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).</p><p>Conclusion</p><p>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.</p></div

PRISMA flow chart of studies identified, included, and excluded in meta-analysis.

<p>PRISMA flow chart of studies identified, included, and excluded in meta-analysis.</p

Forest plots of transfusion using a fixed-effect model.

<p>Squares indicate study-specific risk estimates (size of the square reflects the study-specific statistical weight, i.e., the inverse of the variance); horizontal lines indicate 95% confidence intervals (CIs); diamonds indicate summary risk estimate with its corresponding 95% confidence interval.</p

Forest plots of estimated blood loss using a random-effect model.

<p>Squares indicate study-specific risk estimates (size of the square reflects the study-specific statistical weight, i.e., the inverse of the variance); horizontal lines indicate 95% confidence intervals (CIs); diamonds indicate summary risk estimate with its corresponding 95% confidence interval.</p

Forest plots of overall complicationsusing a fixed-effect model.

<p>Studies are sub-grouped according to pure laparoscopic nephrectomy and hand-assisted laparoscopic nephrectomy. Squares indicate study-specific risk estimates (size of the square reflects the study-specific statistical weight, i.e., the inverse of the variance); horizontal lines indicate 95% confidence intervals (CIs); diamonds indicate summary risk estimate with its corresponding 95% confidence interval.</p

Forest plots of operative time using a fixed-effect model.

<p>Squares indicate study-specific risk estimates (size of the square reflects the study-specific statistical weight, i.e., the inverse of the variance); horizontal lines indicate 95% confidence intervals (CIs); diamonds indicate summary risk estimate with its corresponding 95% confidence interval.</p

Overall analysis of LN vs. ON.

<p>Overall analysis between the two techniques.</p><p>Overall analysis of LN vs. ON.</p

Forest plots of specimen weight using a random-effect model.

<p>Squares indicate study-specific risk estimates (size of the square reflects the study-specific statistical weight, i.e., the inverse of the variance); horizontal lines indicate 95% confidence intervals (CIs); diamonds indicate summary risk estimate with its corresponding 95% confidence interval.</p

Sensitive analysis of all the studies using Metaninf function in Stata 12.0.

<p>Sensitive analysis of all the studies using Metaninf function in Stata 12.0.</p

Forest plots of analgesic requirement using a random-effect model.

<p>Squares indicate study-specific risk estimates (size of the square reflects the study-specific statistical weight, i.e., the inverse of the variance); horizontal lines indicate 95% confidence intervals (CIs); diamonds indicate summary risk estimate with its corresponding 95% confidence interval.</p