Robot-assisted partial nephrectomy (RAPN) is increasingly used for the surgical management of renal masses. Aim of this study was to analyze the available literature regarding the outcomes of RAPN compared to those of open partial nephrectomy (OPN). A literature search was performed up to October 2018 using PubMed, MEDLINE and Embase. Article selection followed the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) principles and Population, Intervention, Comparator, Outcomes (PICO) methodology was used. Population (P) was patients with renal masses who underwent RAPN (I). RAPN was compared with OPN (C). Outcomes of interest were perioperative, oncological and functional outcomes of both surgical procedures (O). Inclusion criteria were: randomized controlled studies andobservational cohort studies comparing RAPN versus OPN, which reported at least one outcome of interest. Twenty-two manuscripts met our inclusion criteria and were included in the systematic review. RAPN was superior to OPN in terms of complication rate in 11 studies while similar results were observed in 9 studies. Positive surgical margins were similar in 13 studies while RAPN had lower surgical margins in 6 studies. Operative and warm ischemia times were longer in OPN in 13 and 10 studies, respectively. Seventeen and 19 studies showed that estimated blood loss and length of hospital stay were higher in RAPN. Estimated glomerular filtration rate decline and chronic kidney disease upstaging decline were similar in the majority of studies. Current evidence demonstrate that RAPN is a reasonable alternative to OPN with regard to oncological and early functional outcomes with a straightforward advantage of improved perioperative morbidity, as expected by minimally invasive techniques. Nevertheless, there is still a great need for well-designed randomized studies with an extended follow-up.

The benefit of adding sentinel node biopsy (SNB) to extended pelvic lymph node dissection (ePLND) remains controversial. The aim of our study was to evaluate biochemical recurrence (BCR) after robot-assisted radical prostatectomy and ePLND in prostate cancer patients, stratified by the application of SNB. The results were compared with the predictions of the updated Memorial Sloan Kettering Cancer Center nomogram. Methods: Between January 2006 and November 2016, 920 patients underwent robot-assisted radical prostatectomy and ePLND with or without SNB (184 and 736 patients, respectively). BCR was defined as 2 consecutive prostate-specific antigen rises of at least 0.2 ng/mL. The Kaplan–Meier method and Cox regression analyses were used to identify predictors of BCR. Results: Median follow-up was 28 mo (interquartile range, 13–56.7 mo). The 5-y BCR-free survival rate was 80.5% and 69.9% in the ePLND+SNB and ePLND groups, respectively. At multivariate analysis, prostate-specific antigen level, primary Gleason grade greater than 3, seminal vesicle invasion, and higher number of removed and positive nodes were independent predictors of BCR in the ePLND group. In the ePLND+SNB group, only the number of positive nodes was an independent predictor of BCR. The overall accuracy of the Memorial Sloan Kettering Cancer Center nomogram was higher in the ePLND+SNB than in the ePLND group. However, the nomogram was underestimating the probability of BCR-free status in the ePLND+SNB group, whereas the ePLND group was performing as predicted. Conclusion: Adding SNB to ePLND improves BCR-free survival, although the precise explanation of this observation remains speculative. Our results should be interpreted cautiously, given the nonrandomized nature and the selection bias of the study.