Transperitoneal versus retroperitoneal laparoscopic nephroureterectomy: a meta-analysis of technical approaches for upper tract urothelial carcinoma.

OBJECTIVE

It was to compare perioperative outcomes between transperitoneal (TLNU) and retroperitoneal (RLNU) approaches for laparoscopic nephroureterectomy in UTUC.

METHODS

Literature pertaining to "TLNU", "RLNU", and "upper-tract urothelial carcinoma (UTUC)" was systematically retrieved from databases, covering the period from January 2000 to July 2024. Quality and risk of bias were assessed utilizing Cochrane Handbook, and extracted basic information and outcome data. Meta-analysis (MA) was conducted utilizing Review Manager 5.3.

RESULTS

The study included a total of 11 articles. The analysis revealed no significant differences between the RLNU and TLNU groups in terms of surgical duration (mean difference (MD) = 2.83, 95% confidence interval (CI): -29.40 to 35.07, Z = 0.17, P = 0.86 > 0.05), time to bowel function recovery (MD = -0.28, 95% CI: -0.81 to 0.25, Z = 1.03, P = 0.30 > 0.05), length of hospital stay (MD = 0.70, 95% CI: -0.51 to 1.91, Z = 1.14, P = 0.26 > 0.05), incidence of complications (MD = 1.02, 95% CI: 0.43 to 2.41, Z = 0.05, P = 0.96 > 0.05), recurrence rate (MD = 1.25, 95% CI: 0.94 to 1.66, Z = 1.55, P = 0.12 > 0.05), and overall survival (OS) rate (MD = 1.07, 95% CI: 0.98 to 1.18, Z = 1.49, P = 0.14 > 0.05). However, a significant difference was observed in intraoperative blood loss (BL) between the RLNU and TLNU groups (MD = 6.78, 95% CI: 2.44 to 11.13, Z = 3.06, P = 0.002 < 0.05).

CONCLUSION

Perioperative outcomes between RLNU and TLNU show significant differences in operative time, bowel recovery, hospital stay, complications, recurrence, and OS. However, RLNU had significantly higher intraoperative blood loss (P < 0.05), though its clinical relevance remains uncertain. This analysis focused on perioperative metrics; long-term oncologic efficacy requires further investigation.