Comparison of outcomes between transperitoneal and retroperitoneal robot-assisted partial nephrectomy: a systematic review and meta-analysis of comparative studies.

OBJECTIVE

To compare the perioperative and functional outcomes of transperitoneal (TP) and retroperitoneal (RP) approaches in robot-assisted partial nephrectomy (RAPN) for renal cell carcinoma (RCC).

METHODS

A systematic literature search of PubMed, Web of Science, Cochrane, Embase, and ClinicalTrials.gov was conducted from inception to April 2026. Comparative studies that reported the outcomes of interest between TP RAPN and RP RAPN for renal cell carcinoma were included. Pooled effective sizes, including odds ratio (OR) and weighted mean differences (WMD) with 95 confidence intervals (CI), were estimated under fixed or random effect models. Further sensitivity analyses were performed to explore potential sources of heterogeneity. The study protocol was prospectively registered on PROSPERO (CRD420261390561).

RESULTS

A total of 32 comparative studies were included, involving 6299 patients in the TP RAPN group and 4583 in the RP RAPN group, respectively. No significant differences were observed in baseline characteristics. Patients undergoing RP RAPN had a shorter operation time (OT, WMD: 15.53 min, 95%CI 9.24-21.83, P < 0.001), lower estimated blood loss (EBL, WMD: 32.34 ml, 95%CI 21.9-42.78, P < 0.001), and shorter length of stay (LOS, WMD: 0.42 days, 95%CI 0.22-0.63, P < 0.001) compared to TP RAPN. No significant differences were observed in warm ischemia time (WIT, P = 0.24), conversion to open or radical surgery (P = 0.11 and P = 0.18, respectively), positive surgical margin (PSM, P = 0.22), overall complications (P = 0.08), major complications (the Clavien-Dindo classification ≥ 3, P = 0.32), or postoperative renal function (postoperative estimated glomerular filtration rate (eGFR): P = 0.22; postoperative 3-6 month eGFR: P = 0.49; postoperative 1-year eGFR: P = 0.55). Further sensitivity analyses validated the above findings.

CONCLUSIONS

This study suggests that the RP RAPN may be superior to TP RAPN in terms of shorter OT, lower EBL, and shorter LOS. Nevertheless, given the limitations of this analysis, these findings should be interpreted cautiously, and further well-designed randomized controlled trials are required to validate our results.