
==== Front
BMC Cancer
BMC Cancer
BMC Cancer
1471-2407
BioMed Central London

12917
10.1186/s12885-024-12917-z
Systematic Review
Comparative efficacy of cryoablation versus robot-assisted partial nephrectomy in the treatment of cT1 renal tumors: a systematic review and meta-analysis
Gao HuiYu 1
Zhou Lin 1
Zhang JiaBin 1
Wang Qiang 1
Luo ZiYuan 3
Xu Qian 1
Tan Ying 1
Shuai Hui 1
Zhou JunJie 1
Cai Xiang 1
Zheng YongBo 1
Shan Wang 4
Duan Xi dancing913@126.com

2
Wu Tao alhawking@163.com

1
1 https://ror.org/01673gn35 grid.413387.a 0000 0004 1758 177X Department of Urology, Affiliated Hospital of North Sichuan Medical College, No. 1 Maoyuan South Road, Shunqing district, Nanchong, Sichuan 637000 P.R. China
2 https://ror.org/01673gn35 grid.413387.a 0000 0004 1758 177X Department of Dermatology, Affiliated Hospital of North Sichuan Medical College, No. 1 Maoyuan South Road Shunqing, Nanchong, Sichuan 637000 P.R. China
3 https://ror.org/05k3sdc46 grid.449525.b 0000 0004 1798 4472 Department of Clinical Medicine, North Sichuan Medical College, No. 234 Fujiang Road Shunqing, Nanchong, Sichuan 637000 P.R. China
4 https://ror.org/0030zas98 grid.16890.36 0000 0004 1764 6123 Department of Biomedical Engineering, Faculty of Engineering, The Hong Kong Polytechnic University, Hong Kong, China
16 9 2024
16 9 2024
2024
24 115010 5 2024
9 9 2024
© The Author(s) 2024
2024
https://creativecommons.org/licenses/by-nc-nd/4.0/ Open Access This article is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License, which permits any non-commercial use, sharing, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if you modified the licensed material. You do not have permission under this licence to share adapted material derived from this article or parts of it. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by-nc-nd/4.0/.
Purpose

This study utilizes a meta-analytic approach to investigate the effects of cryoablation and robot-assisted partial nephrectomy on perioperative outcomes, postoperative renal function, and oncological results in patients.

Methods

This study followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. Four electronic databases (PubMed, Embase, Web of Science, and the Cochrane Library database) were systematically searched to identify relevant studies published in English up to November 2023. The primary outcomes were perioperative results, complications, postoperative renal function and oncologic outcomes. Review Manager 5.4 was used for this analysis.

Results

This study included a total of 10 studies comprising 2,011 patients. Compared to RAPN (Robot-Assisted Partial Nephrectomy), the CA (Cryoablation) group had a shorter hospital stay [MD -1.76 days; 95% CI -3.12 to -0.41; p = 0.01], less blood loss [MD -104.60 ml; 95% CI -152.58 to -56.62; p < 0.0001], and fewer overall complications [OR 0.62; 95% CI 0.45 to 0.86; p = 0.004], but a higher recurrence rate [OR 7.83; 95% CI 4.32 to 14.19; p < 0.00001]. There were no significant differences between the two groups in terms of operative time, minor complications (Clavien-Dindo Grade 1–2), major complications (Clavien-Dindo Grade 3–5), changes in renal function at 12 months post-operation, RFS (Recurrence-Free Survival), and OS (Overall Survival).

Conclusion

The evidence provided by this meta-analysis indicates that the therapeutic effects of Cryoablation (CA) are similar to those of Robot-Assisted Partial Nephrectomy (RAPN) in terms of perioperative outcomes and renal function. However, the recurrence rate of tumors treated with CA is significantly higher.

Systematic review registration

The study has been registered on the International Prospective Register of Systematic Reviews (PROSPERO: CRD42023465846).

Supplementary Information

The online version contains supplementary material available at 10.1186/s12885-024-12917-z.

Keywords

Renal tumors
Ablation
Cryoablation
Robot-assisted partial nephrectomy
Meta-analysis
City of Nanchong Strategic Cooperation with Local Universities Foundation of technology20SXQT0305 The Application and Basic Research Program of Sichuan Science and Technology Department2022NSFSC0804 The Primary Health Development Research Center of Sichuan Province ProgramSWFZ21-C-98 The Medical Research project of Sichuan Medical AssociationS21061 issue-copyright-statement© BioMed Central Ltd., part of Springer Nature 2024
==== Body
pmcIntroduction

Kidney cancer accounts for over 3% of all new cancer cases globally, affecting more than 430,000 people annually. Moreover, the incidence of kidney cancer is on the rise [1]. Recent advancements in imaging technology have enabled earlier diagnosis of kidney cancer for many patients [2]. As a result, a large portion of newly diagnosed renal tumors are asymptomatic and incidentally discovered, with tumor diameters smaller than 7 cm. Partial nephrectomy is generally considered the gold standard for the treatment of renal tumors [3], and now we can achieve better treatment outcomes with the aid of robotic assistance [4]. Recently, ablation therapy has garnered attention as a viable treatment option for patients with multiple comorbidities or deemed unsuitable for surgery [3, 5, 6]. Among ablation techniques, radiofrequency ablation and cryoablation are often preferred as first-line treatments [7]. In fact, compared to radiofrequency ablation, cryoablation can achieve a broader tumor coverage, thereby preventing tumor recurrence [8]. Moreover, cryoablation (CA) is favored due to the visualization of the ablation area, allowing for continuous monitoring of the ablated zone [9, 10]. Therefore, comparative studies between CA and robot-assisted partial nephrectomy (RAPN) are highly meaningful. The purpose of this article is to conduct a systematic review and meta-analysis to evaluate the perioperative, complication, renal function, and oncological outcomes of CA and RAPN.

Methods

This meta-analysis was performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement 2020 [11] (Supplemental Digital Content 1). Quality assessment was performed according to Assessing the Methodological Quality of Systematic Reviews (AMSTAR) 2 (Supplemental Digital Content 2) and was registered in PROSPERO [12].

Eligibility criteria

Eligibility criteria were formulated using the specific population, intervention, comparison, outcomes, and study design (PICOS) framework. This review included studies that met the following criteria: (P): Patients with Clinical stage T1 renal tumors; (I): Treatment with cryoablation technology; (C): Use of robot-assisted surgery as a comparative treatment; (O): Perioperative, renal function, and oncological outcomes; (S): Retrospective and prospective cohort studies. Case series, surveys, letters, editorial comments, reviews, and animal studies were not included. In addition, studies without original data and articles in languages other than English were excluded.

Information sources, search strategy, and selection process

A systematic search was conducted in PubMed, Embase, Web of Science, and the Cochrane Library databases. The search terms used were: (Renal) AND (Neoplasms) AND (Cryoablation) AND (Partial Nephrectomy OR Robot-assisted).

The search results were limited to human studies, including research published from the inception of the databases up to November 1, 2023. Two authors (GHY and ZL) reviewed the articles based on predetermined inclusion/exclusion criteria. Any conflicts regarding eligibility were resolved by the two authors, and any disagreements were resolved by a third party (WT). Studies that met our PICOS criteria were also included.

Data collection process and data items

We extracted relevant data from studies, including study characteristics (first author, year of publication, country, study design, number of participants), baseline demographic data (age, Body Mass Index (BMI), tumor size, RENAL nephrometry score, Charlson comorbidity index(CCI), follow-up period), perioperative outcomes (operative time, hospital stay, blood loss, overall complications, Minor, Clavien 1–2, Major, Clavien 3–5), renal function, and oncological outcomes (recurrence rate, recurrence-free survival, and overall survival).

Risk of bias assessment

The Newcastle–Ottawa Scale (NOS) [13, 14] was used to assess the quality of non-RCT. The NOS checklist includes three quality parameters: population selection (4 points), comparability of cohorts (2 points), and assessment of outcome for cohort studies (3 points). Each study received a score ranging from 0 to 9. Studies with a score of 7 or higher were considered high-quality articles.

Synthesis methods

The meta-analysis included retrospective and prospective cohort studies and was performed using Review Manager 5.4 (Cochrane Collaboration, Oxford, UK). We pooled clinical effect estimates using the mean difference (MD), odds risk (OR), and their respective 95% CIs. The statistical significance level was set at p < 0.05. The Mantel–Haenszel effects model and inverse-variance effects model were used to combine the trials. We calculated and depicted forest plots with a 95% CI. The I² test and Cochran’s Q test were used to assess the heterogeneity. Statistical heterogeneity was indicated by p < 0.05 in the Cochran’s Q test and I² > 50% in the I² test. If heterogeneity existed, a random effect model was adopted; otherwise, a fixed effect model was adopted. I² values of 25%, 50%, and 75% indicate low, moderate, and high levels of inconsistency, respectively [15]. Further sensitivity analyses were conducted to reduce heterogeneity and confirm the reliability of our findings.

Results

Study selection, characteristics, and risk of bias

We initially identified 3,491 articles, of which 10 were selected for further analysis [16–25]. Figure 1 describes the search process (PRISMA flowchart). Among the included 10 studies, there were 2,011 patients involved, with 1,029 (51.2%) in the Cryoablation (CA) group and 982 (48.8%) in the Robot-Assisted Partial Nephrectomy (RAPN) group. All studies were retrospective, and five were propensity score analysis studies [16, 17, 19, 22, 23]. All studies reported perioperative outcomes and complications, with 8 studies providing results on changes in renal function [16, 18, 20–25]. Table 1 provided baseline characteristics of the patients, including age, BMI, sample size, tumor diameter, surgical method, renal nephrometry score, and follow-up period. There was no statistical significance in BMI (P = 0.84), tumor size (P = 0.34), renal nephrometry score (P = 0.05) and CCI (P = 0.13) between the two groups, but the CA group was older than the RAPN group (P < 0.001). The data for perioperative outcomes and renal function changes are provided in Tables 2 and 3, respectively. All included studies were of high quality (Supplemental Digital Content 3).

Fig. 1 PRISMA flowchart

Table 1 Baseline characteristics

		Patients(n)	Age(year)	BMI(kg/m²)	Tumor size(cm)	RENAL ≥ 10(n)	CCI(n)	Surgical approach	Follow-up duration(month)	
Reference	Country	CA	RAPN	CA	RAPN	CA	RAPN	CA	RAPN	CA	RAPN	CA	RAPN		CA	RAPN	
Kawaguchi, S [21]	Japan	49	50	78.44(4.7)	75.35(3.12)	23.7(3.8)	23.1(2.4)	2.4(0.8)	2.7(1.2)	0	1	NA.	NA.	PCA/RAPN	20.1(14.5)	24.3(14.5)	
Uemura, T [25]	Japan	48	78	76.58(9.17)	60.65(12.84)	23.35(3.82)	23(3.02)	2.67(1.07)	1.9(0.6)	5	3	NA.	NA.	PCA/RAPN	16.96(19.87)	20.26(13.6)	
Liu, HY [22]	Taiwan	55	55	59.44(14.77)	57.27(13.28)	25.04(4.23)	25.29(4.58)	3.86(2.13)	4.06(2.01)	14	11	NA.	NA.	LCA/RAPN	54.96(34.59)	33.2(19.55)	
Rembeyo, G [23]	France	55	36	71.67(4.39)	60.09(2.65)	26.92(1.10)	29(1.51)	4.62(0.29)	4.55(0.34)	19	4	NA.	NA.	CA/RAPN	20.14(2.57)	23.73(3.95)	
Fraisse, G [19]	France	177	177	69.94(9.38)	59.89(10.75)	NA.	NA.	2.59(0.86)	2.77(0.92)	10	10	3.21(1.72)	2.87(2.06)	PCA/RAPN	NA.	NA.	
Bertolo, R [16]	America	65	65	79.3(4.1)	79.3(3.3)	27.9(5.9)	27.4(4.9)	3(1)	2.9(1)	NA.	NA.	2.3(1.6)	2(1.5)	PCA/RAPN	45.65(11.37)	36.65(11.37)	
Caputo, P. A [17]	America	31	31	68.47(2.92)	68.47(2.92)	29.77(7.46)	31.49(8.63)	NA.	NA.	NA.	NA.	6(1.48)	4(1.48)	PCA/RAPN	11.71(12.44)	36.16(39.48)	
Emara, A. M [18]	Britain	56	47	69.75(12)	60.5(10.5)	NA.(NA.)	NA.(NA.)	2.56(0.72)	3.28(1.22)	NA.	NA.	NA.	NA.	LCA/RAPN	31.3(13.48)	16.5(6.49)	
Tanagho, Y [24]	America	267	233	69.3(11)	57.4(11.9)	30.4(7.8)	30.1(6)	2.5(1)	2.9(1.5)	NA.	NA.	6.5(2.2)	2.1(1.8)	LCA&PCA/RAPN	39.8(34.3)	21.9(18.8)	
Guillotreau, J [20]	America	226	210	67.4(11.3)	57.8(11.8)	30.1(6.4)	29.3(6.2)	2.2(0.9)	2.4(0.8)	NA.	NA.	NA.	NA.	LCA/RAPN	39.76(43.35)	4.55(5.15)	
CA, Cryoablation

PCA, Percutaneous Cryoablation

LCA, Laparoscopic Cryoablation

RAPN, Robot-Assisted Partial Nephrectomy

BMI, Body Mass Index

R.E.N.A.L. score, Renal Nephrometry Score

CCI, Charlson comorbidity index

Table 2 Perioperative outcomes and complications of the included studies

	Operative time(min)	Hospital stay(day)	Blood loss(ml)	Overall complications(n)	Minor, Clavien 1–2(n)	Major, Clavien 3–5(n)	
Reference	CA	RAPN	CA	RAPN	CA	RAPN	CA	RAPN	CA	RAPN	CA	RAPN	
Kawaguchi, S [21]	NA	NA	NA	NA	NA	NA	0	1	0	0	0	1	
Uemura, T [25]	NA	NA	NA	NA	NA	NA	NA	NA	NA.	NA.	1	2	
Liu, HY [22]	138.56(45.28)	267.45(104.53)	4.15(2.71)	6.11(5.1)	30.73(50.31)	300.56(360.73)	5	2	3	0	2	2	
Rembeyo, G [23]	NA	NA	NA	NA	NA	NA	13	7	13	7	0	0	
Fraisse, G [19]	NA	NA	1.22(1.94)	4.15(3.48)	NA	NA	NA	NA	NA.	NA.	NA.	NA.	
Bertolo, R [16]	140(60)	200(50)	1(1)	4(2)	100(140)	195(139)	6	20	5	16	1	4	
Caputo, P. A [17]	NA	NA	NA	NA	NA	NA	13	7	9	6	4	1	
Emara, A. M [18]	147.88(36.08)	166.02(50.69)	1.68(0.18)	1.38(0.12)	47.14(16.24)	94.26(40.1)	5	4	4	2	1	2	
Tanagho, Y [24]	164.8(60.2)	140.6(41.6)	NA	NA	74.2(100.1)	136.3(112.2)	8	21	4	15	4	6	
Guillotreau, J [20]	175.53(44.77)	180(44.79)	2(1.49)	3.35(0.75)	75(8.87)	200(36.35)	27	42	19	36	8	6	
CA, Cryoablation

RAPN, Robot-Assisted Partial Nephrectomy

Table 3 Renal function

	12 months post-operation(eGFR ml/min/1.73 m2)	
Reference	CA	RAPN	
Kawaguchi, S [21]	-14.1(33.88)	-6.2(17.64)	
Uemura, T [25]	NA	NA	
Liu, HY [22]	NA	NA	
Rembeyo, G [23]	-6.4(3.89)	-6.7(3.89)	
Fraisse, G [19]	NA	NA	
Bertolo, R [16]	NA	NA	
Caputo, P. A [17]	NA	NA	
Emara, A. M [18]	NA	NA	
Tanagho, Y [24]	-5(24.67)	-11.1(21.71)	
Guillotreau, J [20]	NA	NA	
CA, Cryoablation

RAPN, Robot-Assisted Partial Nephrectomy

eGFR, estimated glomerular filtration rate

Assessment of quality

Six studies received a NOS score of 8 [16–19, 22, 23], three studies scored 7 [20, 21, 25], and one study was rated at 6 [24].

Perioperative outcomes and complications

The perioperative meta-analysis results indicate that no statistically significant difference was found between the two groups in terms of operative time (p = 0.05)(Fig. 2A). Notably, the amount of blood loss in the CA group was significantly less than that in the RAPN group [MD -104.60 ml; 95% CI -152.58 to -56.62; p = < 0.0001] (Fig. 2C), and the length of hospital stay for the CA group was also significantly shorter than that for the RAPN group [MD -1.76 days; 95% CI -3.12 to -0.41; p = 0.01](Fig. 2B).

Cumulative analysis of complications showed that the overall incidence of complications was lower in the CA group compared to the RAPN group [OR 0.62; 95% CI 0.45 to 0.86; p = 0.004] (Fig. 2D), but there was no difference between the groups in terms of the occurrence of minor, Clavien 1–2, and major, Clavien 3–5 complications (p = 0.31, p = 0.58) (Fig. 2E, F).

Fig. 2 A-Operative Time, B-Length of Hospital Stay, C-Blood Loss, D-Overall Complications, E-Minor, Clavien 1–2, F-Major, Clavien 3–5

Renal function

The results for changes in renal function 12 months post-surgery are derived from three studies (Table 3). The analysis reveals that there is no significant statistical difference in the changes in kidney function at 12 months post-surgery between the CA group and the RAPN group [MD 1.10; 95% CI -4.33 to 6.54; p = 0.69]. (Fig. 3).

Fig. 3 Renal function 12 months post-surgery

Oncological outcomes

The oncological outcomes between the CA and RAPN groups show no statistical significance in terms of RFS (Recurrence-Free Survival) and OS (Overall Survival) (RFS: p = 0.88; OS: p = 0.92) (Fig. 4B, C). However, in terms of tumor recurrence rates, nine studies reported recurrences16–24, with the CA group showing a significantly higher recurrence rate compared to the RAPN group [OR 7.83; 95% CI 4.32 to 14.19; p < 0.00001] (Fig. 4A).

Fig. 4 A- Recurrence Rate, B-RFS, C-OS

Heterogeneity

The majority of perioperative outcomes and changes in renal function demonstrated moderate to high heterogeneity across studies (operative time, I²=97%; length of hospital stay, I²=99%; blood loss, I²=98%; changes in kidney function, I²=79%), while the heterogeneity in oncological outcomes was lower.

Sensitivity analysis

Due to the significant heterogeneity observed in operative time, length of hospital stay, blood loss, and renal function 12 months post-surgery, sensitivity analyses were conducted to quantify the sources of heterogeneity and assess the robustness of the results. Ultimately, no substantial changes in heterogeneity were found among these outcomes, indicating that the sources of heterogeneity for these four outcomes are stable.

Assessment of publication bias

We were unable to assess publication bias because the testing ability was insufficient when there were 10 or fewer studies [26, 27].

Discussion

This study offers a meta-analysis concerning perioperative outcomes, changes in renal function, and oncological outcomes, meriting further discussion. For localized cT1 renal tumors, robot-assisted partial nephrectomy (RAPN) might be the optimal treatment choice, as RAPN demonstrates favorable oncological outcomes while preserving renal function [3]. Because RAPN, compared to open surgery, demonstrates favorable oncological outcomes while preserving renal function, it is particularly beneficial in reducing the likelihood of high-grade postoperative complications (HGC) in elderly patients and those with comorbidities [28]. Although RAPN can reduce related complications and shorten hospital stay duration for treating cT1 renal tumors [29], it may not be feasible for patients with comorbidities who cannot tolerate RAPN. Cryoablation (CA) as a minimally invasive surgery is a viable treatment option for patients with multiple comorbidities or deemed unsuitable for surgery.

Our analysis indicates that the CA group had better outcomes in terms of hospital stay, blood loss, and overall complications compared to the RAPN group, possibly due to the complex tissue dissection required by RAPN, leading to longer hospital stay, postoperative blood loss, and complications. However, studies suggest no difference in overall complication rates between the CA and RAPN groups [30, 31], and discrepancies could arise from the insufficiency of results included in the meta-analysis. When categorized into Minor, Clavien 1–2, and Major, Clavien 3–5, CA slightly outperforms RAPN, but without significant statistical significance, aligning with related research [25, 32].

Regarding renal function, some studies suggest CA provides better renal function protection than PN [33], as PN often requires clamping of the renal artery during surgery, leading to renal ischemia and a decrease in renal function [34]. CA can be performed with 3D localization and real-time monitoring of the ablation range under CT/MRI imaging, which helps minimize renal parenchymal damage and ischemia, thereby preserving kidney function [35, 36]. Despite the theoretical advantages of RAPN in providing finer dissection and better treatment outcomes, no significant difference in renal function between the two treatments was observed. This could be due to CA being more commonly used in older patients with multiple comorbidities, and the glomerular filtration rate decreases with age [37], while comorbidities can also affect the glomerular filtration rate [38]. Moreover, some studies have indicated that surgical experience can also impact the quality of perioperative outcomes, with more experienced surgeons significantly improving perioperative results, particularly in terms of WIT and operative time [39–41]. Certainly, the impact of precision medicine on surgical outcomes cannot be excluded. Nowadays, 3D virtual models (3DVM) are being utilized in preoperative assessment and to assist in performing RAPN. Compared to cases without the use of 3DVM, the group utilizing 3DVM shows a further reduction in renal ischemia rates, thereby better preserving renal function [42, 43]. Some studies indicate both CA and PN can adequately preserve renal function [44, 45]. For this controversial outcome, further high-quality research is needed for confirmation.

The difference in RFS and OS between the two groups is minimal, with some reports indicating better RFS with RAPN compared to CA [17], and others suggesting RAPN has better RFS but similar OS compared to CA [24]. Given these findings, further research is required to verify these long-term outcomes. The recurrence rate is significantly higher in the CA group compared to the RAPN group, aligning with findings by T. Klatte [46]. Any form of anatomical removal surgery ensures better local tumor clearance than CA.

This study has several limitations. First, the meta-analysis included retrospective or prospective cohort studies, lacking high-quality randomized controlled trials, thus inherent selection bias may affect these studies. Second, different CA techniques (PCA, LCA) were included in the review without sufficient literature to conduct a subgroup analysis on CA techniques, possibly leading to high heterogeneity. Third, CA is often used in older patients with multiple comorbidities, potentially increasing data heterogeneity. Fourth, only two to three outcomes were included for oncological outcomes such as RFS and OS, making the results less reliable. Fifth, renal function should be staged and analyzed according to acute and chronic kidney failure. However, we were only able to collect data at 12 months postoperatively from the original data, making the analysis of the impact of the two treatment modalities on renal function less comprehensive. Sixth, the data we have collected do not yet support subgroup analysis of patients with cT1a and cT1b tumors together, and further research is needed in the future. Finally, variations in surgical experience and equipment may lead to differences in outcomes. Regarding heterogeneity, caution is advised for low heterogeneity, as von Hippel PT demonstrated significant bias in I² when the number of included studies is small [47]. Some of the included studies exhibit significant heterogeneity, but due to differences in surgical techniques, medical equipment, and countries, the results require further validation.

Conclusion

In summary, CA slightly outperforms RAPN in terms of perioperative outcomes, but there are no significant differences between the two in terms of renal function and oncological outcomes (except for recurrence rate). For patients who cannot tolerate RAPN treatment, CA remains a viable treatment option. However, due to the limited number and quality of studies included, there is great heterogeneity for most of the variables and oncological results are based on very few studies, further research is needed to validate these findings.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Supplementary Material 1

Supplementary Material 2

Supplementary Material 3

Author contributions

TW and XD had full access to all the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis. Study concept and design: TW, HYG and LZ. Acquisition of data: HYG and LZ. Analysis and interpretation of data: HYG, LZ, JBZ, QW, HS and XC. Drafting of the manuscript: HYG, LZ, JBZ, QW and QX. Critical revision of the manuscript for important intellectual content: HYG, LZ, JJZ, WS, XD and TW. Statistical analysis: HYG, LZ, ZYL, YBZ and YT. Supervision: XD, TW. All authors contributed to the article and approved the submitted version. †Equal contributors: This author has contributed equally to this work and share first authorship.

Funding

This work was supported by City of Nanchong Strategic Cooperation with Local Universities Foundation of technology (20SXQT0305), The Application and Basic Research Program of Sichuan Science and Technology Department (2022NSFSC0804), The Primary Health Development Research Center of Sichuan Province Program (SWFZ21-C-98), The Medical Research project of Sichuan Medical Association(S21061).

Data availability

No datasets were generated or analysed during the current study.

Declarations

Ethical approval

Not applicable.

Human ethics and consent to participate

Not applicable.

Competing interests

The authors declare no competing interests.

Abbreviations

CA Cryoablation

PCA Percutaneous Cryoablation

LCA Laparoscopic Cryoablation

RFA Radiofrequency Ablation

RAPN Robot-Assisted Partial Nephrectomy

OPN Open Partial Nephrectomy

PN Partial Nephrectomy

MD Mean Difference

OR Odds Risk

CI Confidence Interval

BMI Body Mass Index

R.E.N.A.L. score Renal Nephrometry Score

CCI Charlson comorbidity index

eGFR Estimated glomerular filtration rate

RFS Recurrence-free Survival

OS Overall Survival

CT Computed Tomography

MRI Magnetic Resonance Imaging

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

HuiYu Gao, Lin Zhou, JiaBin Zhang and Qiang Wang contributed equally to this work and share first authorship.
==== Refs
References

1. Bukavina L Bensalah K Bray F Carlo M Challacombe B Karam JA Kassouf W Mitchell T Montironi R O’Brien T Epidemiology of renal cell carcinoma: 2022 update Eur Urol 2022 82 5 529 42 10.1016/j.eururo.2022.08.019 36100483
Bukavina L, Bensalah K, Bray F, Carlo M, Challacombe B, Karam JA, Kassouf W, Mitchell T, Montironi R, O’Brien T, et al. Epidemiology of renal cell carcinoma: 2022 update. Eur Urol. 2022;82(5):529–42.36100483 10.1016/j.eururo.2022.08.019
2. Diana P Klatte T Amparore D Bertolo R Carbonara U Erdem S Ingels A Kara O Marandino L Marchioni M Screening programs for renal cell carcinoma: a systematic review by the EAU young academic urologists renal cancer working group World J Urol 2023 41 4 929 40 10.1007/s00345-022-03993-6 35362747
Diana P, Klatte T, Amparore D, Bertolo R, Carbonara U, Erdem S, Ingels A, Kara O, Marandino L, Marchioni M, et al. Screening programs for renal cell carcinoma: a systematic review by the EAU young academic urologists renal cancer working group. World J Urol. 2023;41(4):929–40.35362747 10.1007/s00345-022-03993-6
3. Ljungberg B Albiges L Abu-Ghanem Y Bedke J Capitanio U Dabestani S Fernández-Pello S Giles RH Hofmann F Hora M European Association of Urology Guidelines on Renal Cell Carcinoma: the 2022 Update Eur Urol 2022 82 4 399 410 10.1016/j.eururo.2022.03.006 35346519
Ljungberg B, Albiges L, Abu-Ghanem Y, Bedke J, Capitanio U, Dabestani S, Fernández-Pello S, Giles RH, Hofmann F, Hora M, et al. European Association of Urology Guidelines on Renal Cell Carcinoma: the 2022 Update. Eur Urol. 2022;82(4):399–410.35346519 10.1016/j.eururo.2022.03.006
4. Ni Y Yang X A systematic review and Meta-analysis of comparison of outcomes of Robot-assisted versus open partial nephrectomy in clinical T1 renal cell carcinoma patients Urol Int 2022 106 8 757 67 10.1159/000521881 35193139
Ni Y, Yang X. A systematic review and Meta-analysis of comparison of outcomes of Robot-assisted versus open partial nephrectomy in clinical T1 renal cell carcinoma patients. Urol Int. 2022;106(8):757–67.35193139 10.1159/000521881
5. Salagierski M Wojciechowska A Zając K Klatte T Thompson RH Cadeddu JA Kaouk J Autorino R Ahrar K Capitanio U The role of ablation and minimally invasive techniques in the management of small renal masses Eur Urol Oncol 2018 1 5 395 402 10.1016/j.euo.2018.08.029 31158078
Salagierski M, Wojciechowska A, Zając K, Klatte T, Thompson RH, Cadeddu JA, Kaouk J, Autorino R, Ahrar K, Capitanio U, et al. The role of ablation and minimally invasive techniques in the management of small renal masses. Eur Urol Oncol. 2018;1(5):395–402.31158078 10.1016/j.euo.2018.08.029
6. Kwak K Yu B Lewandowski RJ Kim D-H Recent progress in cryoablation cancer therapy and nanoparticles mediated cryoablation Theranostics 2022 12 5 2175 204 10.7150/thno.67530 35265206
Kwak K, Yu B, Lewandowski RJ, Kim D-H. Recent progress in cryoablation cancer therapy and nanoparticles mediated cryoablation. Theranostics. 2022;12(5):2175–204.35265206 10.7150/thno.67530
7. Campbell SC Clark PE Chang SS Karam JA Souter L Uzzo RG Renal Mass and localized renal Cancer: evaluation, management, and Follow-Up: AUA Guideline: part I J Urol 2021 206 2 199 208 10.1097/JU.0000000000001911 34115547
Campbell SC, Clark PE, Chang SS, Karam JA, Souter L, Uzzo RG. Renal Mass and localized renal Cancer: evaluation, management, and Follow-Up: AUA Guideline: part I. J Urol. 2021;206(2):199–208.34115547 10.1097/JU.0000000000001911
8. El Dib R Touma NJ Kapoor A Cryoablation vs radiofrequency ablation for the treatment of renal cell carcinoma: a meta-analysis of case series studies BJU Int 2012 110 4 510 6 10.1111/j.1464-410X.2011.10885.x 22304329
El Dib R, Touma NJ, Kapoor A. Cryoablation vs radiofrequency ablation for the treatment of renal cell carcinoma: a meta-analysis of case series studies. BJU Int. 2012;110(4):510–6.22304329 10.1111/j.1464-410X.2011.10885.x
9. Cazzato RL Garnon J Ramamurthy N Koch G Tsoumakidou G Caudrelier J Arrigoni F Zugaro L Barile A Masciocchi C Percutaneous image-guided cryoablation: current applications and results in the oncologic field Med Oncol 2016 33 12 140 10.1007/s12032-016-0848-3 27837451
Cazzato RL, Garnon J, Ramamurthy N, Koch G, Tsoumakidou G, Caudrelier J, Arrigoni F, Zugaro L, Barile A, Masciocchi C, et al. Percutaneous image-guided cryoablation: current applications and results in the oncologic field. Med Oncol. 2016;33(12):140.27837451 10.1007/s12032-016-0848-3
10. Hasegawa T Yamanaka T Gobara H Miyazaki M Takaki H Sato Y Inaba Y Yamakado K Radiofrequency ablation versus cryoablation for T1b renal cell carcinoma: a multi-center study Japanese J Radiol 2018 36 9 551 8 10.1007/s11604-018-0756-x
Hasegawa T, Yamanaka T, Gobara H, Miyazaki M, Takaki H, Sato Y, Inaba Y, Yamakado K. Radiofrequency ablation versus cryoablation for T1b renal cell carcinoma: a multi-center study. Japanese J Radiol. 2018;36(9):551–8.10.1007/s11604-018-0756-x
11. Page MJ McKenzie JE Bossuyt PM Boutron I Hoffmann TC Mulrow CD Shamseer L Tetzlaff JM Akl EA Brennan SE The PRISMA 2020 statement: an updated guideline for reporting systematic reviews BMJ (Clinical Res ed) 2021 372 n71
Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, Shamseer L, Tetzlaff JM, Akl EA, Brennan SE, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ (Clinical Res ed). 2021;372:n71.
12. Shea BJ Reeves BC Wells G Thuku M Hamel C Moran J Moher D Tugwell P Welch V Kristjansson E AMSTAR 2: a critical appraisal tool for systematic reviews that include randomised or non-randomised studies of healthcare interventions, or both BMJ (Clinical Res ed) 2017 358 j4008 10.1136/bmj.j4008
Shea BJ, Reeves BC, Wells G, Thuku M, Hamel C, Moran J, Moher D, Tugwell P, Welch V, Kristjansson E, et al. AMSTAR 2: a critical appraisal tool for systematic reviews that include randomised or non-randomised studies of healthcare interventions, or both. BMJ (Clinical Res ed). 2017;358:j4008.10.1136/bmj.j4008
13. Ottawa Hospital Research Institute. Newcastle-Ottawa quality assessment scale cohort studies. (2021). http://www.ohri.ca/programs/clinical_epidemiology/nosgen.pdf (Accessed Jan 03, 2022). In.
14. Ottawa Hospital Research Institute. Coding manual for cohort studies. (2021). http://www.ohri.ca/programs/clinical_epidemiology/nos_manual.pdf (Accessed Apr 06, 2023). In.
15. Higgins JPT Thompson SG Deeks JJ Altman DG Measuring inconsistency in meta-analyses BMJ (Clinical Res ed) 2003 327 7414 557 60 10.1136/bmj.327.7414.557
Higgins JPT, Thompson SG, Deeks JJ, Altman DG. Measuring inconsistency in meta-analyses. BMJ (Clinical Res ed). 2003;327(7414):557–60.10.1136/bmj.327.7414.557
16. Bertolo R Garisto J Armanyous S Agudelo J Lioudis M Kaouk J Perioperative, oncological and functional outcomes after robotic partial nephrectomy vs. cryoablation in the elderly: a propensity score matched analysis Urol Oncol 2019 37 4 e294299 294215 10.1016/j.urolonc.2018.12.016
Bertolo R, Garisto J, Armanyous S, Agudelo J, Lioudis M, Kaouk J. Perioperative, oncological and functional outcomes after robotic partial nephrectomy vs. cryoablation in the elderly: a propensity score matched analysis. Urol Oncol. 2019;37(4):e294299–294215.10.1016/j.urolonc.2018.12.016
17. Caputo PA Zargar H Ramirez D Andrade HS Akca O Gao T Kaouk JH Cryoablation versus partial nephrectomy for clinical T1b renal tumors: a Matched Group comparative analysis Eur Urol 2017 71 1 111 7 10.1016/j.eururo.2016.08.039 27568064
Caputo PA, Zargar H, Ramirez D, Andrade HS, Akca O, Gao T, Kaouk JH. Cryoablation versus partial nephrectomy for clinical T1b renal tumors: a Matched Group comparative analysis. Eur Urol. 2017;71(1):111–7.27568064 10.1016/j.eururo.2016.08.039
18. Emara AM Kommu SS Hindley RG Barber NJ Robot-assisted partial nephrectomy vs laparoscopic cryoablation for the small renal mass: redefining the minimally invasive ‘gold standard’ BJU Int 2014 113 1 92 9 10.1111/bju.12252 24053473
Emara AM, Kommu SS, Hindley RG, Barber NJ. Robot-assisted partial nephrectomy vs laparoscopic cryoablation for the small renal mass: redefining the minimally invasive ‘gold standard’. BJU Int. 2014;113(1):92–9.24053473 10.1111/bju.12252
19. Fraisse G Colleter L Peyronnet B Khene ZE Mandoorah Q Soorojebally Y Bourgi A De La Taille A Roupret M De Kerviler E Peri-operative and local control outcomes of robot-assisted partial nephrectomy vs percutaneous cryoablation for renal masses: comparison after matching on radiological stage and renal score BJU Int 2019 123 4 632 8 10.1111/bju.14530 30153399
Fraisse G, Colleter L, Peyronnet B, Khene ZE, Mandoorah Q, Soorojebally Y, Bourgi A, De La Taille A, Roupret M, De Kerviler E, et al. Peri-operative and local control outcomes of robot-assisted partial nephrectomy vs percutaneous cryoablation for renal masses: comparison after matching on radiological stage and renal score. BJU Int. 2019;123(4):632–8.30153399 10.1111/bju.14530
20. Guillotreau J Haber GP Autorino R Miocinovic R Hillyer S Hernandez A Laydner H Yakoubi R Isac W Long JA Robotic partial nephrectomy versus laparoscopic cryoablation for the small renal mass Eur Urol 2012 61 5 899 904 10.1016/j.eururo.2012.01.007 22264680
Guillotreau J, Haber GP, Autorino R, Miocinovic R, Hillyer S, Hernandez A, Laydner H, Yakoubi R, Isac W, Long JA, et al. Robotic partial nephrectomy versus laparoscopic cryoablation for the small renal mass. Eur Urol. 2012;61(5):899–904.22264680 10.1016/j.eururo.2012.01.007
21. Kawaguchi S, Izumi K, Naito R, Kadomoto S, Iwamoto H, Yaegashi H, Nohara T, Shigehara K, Yoshida K, Kadono Y et al. Comparison of Clinical Outcomes between Robot-Assisted Partial Nephrectomy and Cryoablation in Elderly Patients with Renal Cancer. Cancers (Basel) 2022, 14(23).
22. Liu HY, Kang CH, Wang HJ, Chen CH, Luo HL, Chen YT, Cheng YT, Chiang PH. Comparison of robot-assisted laparoscopic partial nephrectomy with laparoscopic cryoablation in the treatment of localised renal tumours: A propensity score-matched comparison of long-term outcomes. Diagnostics 2021, 11(5).
23. Rembeyo G Correas JM Jantzen R Audenet F Dariane C Delavaud C Mejean A Timsit MO Percutaneous ablation Versus Robotic partial nephrectomy in the treatment of cT1b renal tumors: oncologic and functional outcomes of a Propensity score-weighted analysis Clin Genitourin Cancer 2020 18 2 138 47 10.1016/j.clgc.2019.10.006 31982346
Rembeyo G, Correas JM, Jantzen R, Audenet F, Dariane C, Delavaud C, Mejean A, Timsit MO. Percutaneous ablation Versus Robotic partial nephrectomy in the treatment of cT1b renal tumors: oncologic and functional outcomes of a Propensity score-weighted analysis. Clin Genitourin Cancer. 2020;18(2):138–47.31982346 10.1016/j.clgc.2019.10.006
24. Tanagho Y Kim E Bhayani S Figenshau R Renal cryoablation versus robotassisted partial nephrectomy: single-center experience J Endourol 2013 27 A399 10.1089/end.2013.0192
Tanagho Y, Kim E, Bhayani S, Figenshau R. Renal cryoablation versus robotassisted partial nephrectomy: single-center experience. J Endourol. 2013;27:A399.10.1089/end.2013.0192
25. Uemura T Kato T Nagahara A Kawashima A Hatano K Ujike T Ono Y Higashihara H Fujita K Fukuhara S Therapeutic and clinical outcomes of Robot-assisted partial nephrectomy Versus Cryoablation for T1 renal cell carcinoma Vivo 2021 35 3 1573 9 10.21873/invivo.12413
Uemura T, Kato T, Nagahara A, Kawashima A, Hatano K, Ujike T, Ono Y, Higashihara H, Fujita K, Fukuhara S, et al. Therapeutic and clinical outcomes of Robot-assisted partial nephrectomy Versus Cryoablation for T1 renal cell carcinoma. Vivo. 2021;35(3):1573–9.10.21873/invivo.12413
26. Sterne JA Gavaghan D Egger M Publication and related bias in meta-analysis: power of statistical tests and prevalence in the literature J Clin Epidemiol 2000 53 11 1119 29 10.1016/S0895-4356(00)00242-0 11106885
Sterne JA, Gavaghan D, Egger M. Publication and related bias in meta-analysis: power of statistical tests and prevalence in the literature. J Clin Epidemiol. 2000;53(11):1119–29.11106885 10.1016/S0895-4356(00)00242-0
27. Lau J Ioannidis JPA Terrin N Schmid CH Olkin I The case of the misleading funnel plot BMJ (Clinical Res ed) 2006 333 7568 597 600 10.1136/bmj.333.7568.597
Lau J, Ioannidis JPA, Terrin N, Schmid CH, Olkin I. The case of the misleading funnel plot. BMJ (Clinical Res ed). 2006;333(7568):597–600.10.1136/bmj.333.7568.597
28. Borregales LD Pecoraro A Roussel E Mari A Grosso AA Checcucci E Montorsi F Larcher A Van Poppel H Porpiglia F Morbidity of elective surgery for localized renal masses among elderly patients: a contemporary multicenter study Eur J Surg Oncol 2023 49 10 107014 10.1016/j.ejso.2023.107014 37573666
Borregales LD, Pecoraro A, Roussel E, Mari A, Grosso AA, Checcucci E, Montorsi F, Larcher A, Van Poppel H, Porpiglia F, et al. Morbidity of elective surgery for localized renal masses among elderly patients: a contemporary multicenter study. Eur J Surg Oncol. 2023;49(10):107014.37573666 10.1016/j.ejso.2023.107014
29. Rosiello G Palumbo C Deuker M Stolzenbach LF Martin T Tian Z Larcher A Capitanio U Montorsi F Shariat SF Partial nephrectomy in frail patients: benefits of robot-assisted surgery Surg Oncol 2021 38 101588 10.1016/j.suronc.2021.101588 33945961
Rosiello G, Palumbo C, Deuker M, Stolzenbach LF, Martin T, Tian Z, Larcher A, Capitanio U, Montorsi F, Shariat SF, et al. Partial nephrectomy in frail patients: benefits of robot-assisted surgery. Surg Oncol. 2021;38:101588.33945961 10.1016/j.suronc.2021.101588
30. Rai BP Jones P Tait C Amitharaj R Gowda R Bhatti A Adshead J Somani B Is cryotherapy a genuine rival to robotic-assisted partial nephrectomy in the management of suspected renal malignancy? A systematic review and Meta-analysis Urology 2018 118 6 11 10.1016/j.urology.2017.09.008 28962877
Rai BP, Jones P, Tait C, Amitharaj R, Gowda R, Bhatti A, Adshead J, Somani B. Is cryotherapy a genuine rival to robotic-assisted partial nephrectomy in the management of suspected renal malignancy? A systematic review and Meta-analysis. Urology. 2018;118:6–11.28962877 10.1016/j.urology.2017.09.008
31. Yanagisawa T Mori K Kawada T Motlagh RS Mostafaei H Quhal F Laukhtina E Rajwa P Aydh A König F Differential efficacy of ablation therapy versus partial nephrectomy between clinical T1a and T1b renal tumors: a systematic review and meta-analysis Urologic Oncology: Seminars Original Investigations 2022 40 7 315 30 10.1016/j.urolonc.2022.04.002 35562311
Yanagisawa T, Mori K, Kawada T, Motlagh RS, Mostafaei H, Quhal F, Laukhtina E, Rajwa P, Aydh A, König F, et al. Differential efficacy of ablation therapy versus partial nephrectomy between clinical T1a and T1b renal tumors: a systematic review and meta-analysis. Urologic Oncology: Seminars Original Investigations. 2022;40(7):315–30.35562311 10.1016/j.urolonc.2022.04.002
32. Bianchi L Chessa F Piazza P Ercolino A Mottaran A Recenti D Serra C Gaudiano C Cappelli A Modestino F Percutaneous ablation or minimally invasive partial nephrectomy for cT1a renal masses? A propensity score-matched analysis Int J Urology: Official J Japanese Urol Association 2022 29 3 222 8 10.1111/iju.14758
Bianchi L, Chessa F, Piazza P, Ercolino A, Mottaran A, Recenti D, Serra C, Gaudiano C, Cappelli A, Modestino F, et al. Percutaneous ablation or minimally invasive partial nephrectomy for cT1a renal masses? A propensity score-matched analysis. Int J Urology: Official J Japanese Urol Association. 2022;29(3):222–8.10.1111/iju.14758
33. Deng W Chen L Wang Y Liu X Wang G Liu W Zhang C Zhou X Li Y Fu B Cryoablation versus partial nephrectomy for clinical stage T1 renal masses: a systematic review and Meta-analysis J Cancer 2019 10 5 1226 36 10.7150/jca.28881 30854132
Deng W, Chen L, Wang Y, Liu X, Wang G, Liu W, Zhang C, Zhou X, Li Y, Fu B. Cryoablation versus partial nephrectomy for clinical stage T1 renal masses: a systematic review and Meta-analysis. J Cancer. 2019;10(5):1226–36.30854132 10.7150/jca.28881
34. Deng W Liu X Hu J Chen L Fu B Off-clamp partial nephrectomy has a positive impact on short- and long-term renal function: a systematic review and meta-analysis BMC Nephrol 2018 19 1 188 10.1186/s12882-018-0993-3 30064370
Deng W, Liu X, Hu J, Chen L, Fu B. Off-clamp partial nephrectomy has a positive impact on short- and long-term renal function: a systematic review and meta-analysis. BMC Nephrol. 2018;19(1):188.30064370 10.1186/s12882-018-0993-3
35. Bhindi B Mason RJ Haddad MM Boorjian SA Leibovich BC Atwell TD Weisbrod AJ Schmit GD Thompson RH Outcomes after Cryoablation Versus partial nephrectomy for sporadic renal tumors in a solitary kidney: a propensity score analysis Eur Urol 2018 73 2 254 9 10.1016/j.eururo.2017.09.009 28967553
Bhindi B, Mason RJ, Haddad MM, Boorjian SA, Leibovich BC, Atwell TD, Weisbrod AJ, Schmit GD, Thompson RH. Outcomes after Cryoablation Versus partial nephrectomy for sporadic renal tumors in a solitary kidney: a propensity score analysis. Eur Urol. 2018;73(2):254–9.28967553 10.1016/j.eururo.2017.09.009
36. Krokidis ME Kitrou P Spiliopoulos S Karnabatidis D Katsanos K Image-guided minimally invasive treatment for small renal cell carcinoma Insights Imaging 2018 9 3 385 90 10.1007/s13244-018-0607-4 29626285
Krokidis ME, Kitrou P, Spiliopoulos S, Karnabatidis D, Katsanos K. Image-guided minimally invasive treatment for small renal cell carcinoma. Insights Imaging. 2018;9(3):385–90.29626285 10.1007/s13244-018-0607-4
37. Eriksen BO Palsson R Ebert N Melsom T van der Giet M Gudnason V Indridason OS Inker LA Jenssen TG Levey AS GFR in healthy aging: an Individual Participant Data Meta-Analysis of Iohexol Clearance in European Population-based cohorts J Am Soc Nephrology: JASN 2020 31 7 1602 15 10.1681/ASN.2020020151 32499396
Eriksen BO, Palsson R, Ebert N, Melsom T, van der Giet M, Gudnason V, Indridason OS, Inker LA, Jenssen TG, Levey AS, et al. GFR in healthy aging: an Individual Participant Data Meta-Analysis of Iohexol Clearance in European Population-based cohorts. J Am Soc Nephrology: JASN. 2020;31(7):1602–15.32499396 10.1681/ASN.2020020151
38. Abdulkader RCRM Burdmann EA Lebrão ML Duarte YAO Zanetta DMT Aging and decreased glomerular filtration rate: an elderly population-based study PLoS ONE 2017 12 12 e0189935 10.1371/journal.pone.0189935 29261774
Abdulkader RCRM, Burdmann EA, Lebrão ML, Duarte YAO, Zanetta DMT. Aging and decreased glomerular filtration rate: an elderly population-based study. PLoS ONE. 2017;12(12):e0189935.29261774 10.1371/journal.pone.0189935
39. Larcher A Muttin F Peyronnet B De Naeyer G Khene ZE Dell’Oglio P Ferreiro C Schatteman P Capitanio U D’Hondt F The learning curve for Robot-assisted partial nephrectomy: impact of Surgical Experience on Perioperative outcomes Eur Urol 2019 75 2 253 6 10.1016/j.eururo.2018.08.042 30243798
Larcher A, Muttin F, Peyronnet B, De Naeyer G, Khene ZE, Dell’Oglio P, Ferreiro C, Schatteman P, Capitanio U, D’Hondt F, et al. The learning curve for Robot-assisted partial nephrectomy: impact of Surgical Experience on Perioperative outcomes. Eur Urol. 2019;75(2):253–6.30243798 10.1016/j.eururo.2018.08.042
40. Campi R Grosso AA Lane BR O DEC Sanguedolce F Hatzichristodoulou G Antonelli A Noyes S Mari FDIM Impact of Trifecta definition on rates and predictors of successful robotic partial nephrectomy for localized renal masses: results from the surface-intermediate-base margin score International Consortium Minerva Urol Nephrol 2022 74 2 186 93 10.23736/S2724-6051.21.04601-2 35345387
Campi R, Grosso AA, Lane BR, O DEC, Sanguedolce F, Hatzichristodoulou G, Antonelli A, Noyes S, Mari FDIM. Impact of Trifecta definition on rates and predictors of successful robotic partial nephrectomy for localized renal masses: results from the surface-intermediate-base margin score International Consortium. Minerva Urol Nephrol. 2022;74(2):186–93.35345387 10.23736/S2724-6051.21.04601-2
41. Harke NN Kuczyk MA Huusmann S Schiefelbein F Schneller A Schoen G Wiesinger C Pfuner J Ubrig B Gloger S Impact of Surgical Experience before Robot-assisted partial nephrectomy on Surgical outcomes: a Multicenter analysis of 2500 patients Eur Urol Open Sci 2022 46 45 52 10.1016/j.euros.2022.10.003 36506259
Harke NN, Kuczyk MA, Huusmann S, Schiefelbein F, Schneller A, Schoen G, Wiesinger C, Pfuner J, Ubrig B, Gloger S, et al. Impact of Surgical Experience before Robot-assisted partial nephrectomy on Surgical outcomes: a Multicenter analysis of 2500 patients. Eur Urol Open Sci. 2022;46:45–52.36506259 10.1016/j.euros.2022.10.003
42. Grosso AA Di Maida F Tellini R Mari A Sforza S Masieri L Carini M Minervini A Robot-assisted partial nephrectomy with 3D preoperative surgical planning: video presentation of the florentine experience Int Braz J Urol 2021 47 6 1272 3 10.1590/s1677-5538.ibju.2020.1075 34156192
Grosso AA, Di Maida F, Tellini R, Mari A, Sforza S, Masieri L, Carini M, Minervini A. Robot-assisted partial nephrectomy with 3D preoperative surgical planning: video presentation of the florentine experience. Int Braz J Urol. 2021;47(6):1272–3.34156192 10.1590/s1677-5538.ibju.2020.1075
43. Grosso AA Di Maida F Lambertini L Cadenar A Coco S Ciaralli E Salamone V Vittori G Tuccio A Mari A Three-dimensional virtual model for robot-assisted partial nephrectomy: a propensity-score matching analysis with a contemporary control group World J Urol 2024 42 1 338 10.1007/s00345-024-05043-9 38767673
Grosso AA, Di Maida F, Lambertini L, Cadenar A, Coco S, Ciaralli E, Salamone V, Vittori G, Tuccio A, Mari A, et al. Three-dimensional virtual model for robot-assisted partial nephrectomy: a propensity-score matching analysis with a contemporary control group. World J Urol. 2024;42(1):338.38767673 10.1007/s00345-024-05043-9
44. Mason RJ Atwell TD Lohse C Bhindi B Weisbrod A Boorjian SA Leibovich BC Schmit GD Thompson RH Renal functional outcomes in patients undergoing percutaneous cryoablation or partial nephrectomy for a solitary renal mass BJU Int 2017 120 4 544 9 10.1111/bju.13917 28548236
Mason RJ, Atwell TD, Lohse C, Bhindi B, Weisbrod A, Boorjian SA, Leibovich BC, Schmit GD, Thompson RH. Renal functional outcomes in patients undergoing percutaneous cryoablation or partial nephrectomy for a solitary renal mass. BJU Int. 2017;120(4):544–9.28548236 10.1111/bju.13917
45. Larcher A Meskawi M Valdivieso R Boehm K Trudeau V Tian Z Fossati N Dell’Oglio P Lughezzani G Buffi N Comparison of renal function detriments after local tumor ablation or partial nephrectomy for renal cell carcinoma World J Urol 2016 34 3 383 9 10.1007/s00345-015-1606-4 26047653
Larcher A, Meskawi M, Valdivieso R, Boehm K, Trudeau V, Tian Z, Fossati N, Dell’Oglio P, Lughezzani G, Buffi N, et al. Comparison of renal function detriments after local tumor ablation or partial nephrectomy for renal cell carcinoma. World J Urol. 2016;34(3):383–9.26047653 10.1007/s00345-015-1606-4
46. Klatte T Shariat SF Remzi M Systematic review and meta-analysis of perioperative and oncologic outcomes of laparoscopic cryoablation versus laparoscopic partial nephrectomy for the treatment of small renal tumors J Urol 2014 191 5 1209 17 10.1016/j.juro.2013.11.006 24231845
Klatte T, Shariat SF, Remzi M. Systematic review and meta-analysis of perioperative and oncologic outcomes of laparoscopic cryoablation versus laparoscopic partial nephrectomy for the treatment of small renal tumors. J Urol. 2014;191(5):1209–17.24231845 10.1016/j.juro.2013.11.006
47. von Hippel PT The heterogeneity statistic I(2) can be biased in small meta-analyses BMC Med Res Methodol 2015 15 35 10.1186/s12874-015-0024-z 25880989
von Hippel PT. The heterogeneity statistic I(2) can be biased in small meta-analyses. BMC Med Res Methodol. 2015;15:35.25880989 10.1186/s12874-015-0024-z
