OPEN VERSUS LAPAROSCOPIC NEPHRECTOMY FOR RENAL TUMORS: A SYSTEMATIC REVIEW AND META-ANALYSIS OF PERIOPERATIVE, FUNCTIONAL AND ONCOLOGIC OUTCOMES

Background: Renal tumors are increasingly detected early due to widespread imaging. For localized tumors, particularly stage T1, partial nephrectomy (PN) is the standard of care, offering oncological efficacy while preservingrenal function. Laparoscopic partial nephrectomy (LPN) has been increasingly adopted, yet comparative outcomes with open partial nephrectomy (OPN) remain actively evaluated. Aim: To systematically review perioperative, functional, and oncological outcomes of LPN versus OPN in patients with localized renal tumors, including the impact of tumor anatomical complexity. Materials and Methods: A systematic literature search of PubMed identified comparative studies of LPN versus OPN for T1–T1b renal tumors. Extracted data included operative time, estimated blood loss, complications, renalfunction, oncological outcomes, and tumor complexity assessed by nephrometry scores. Results: LPN showed perioperative advantages, including reduced blood loss and shorter hospital stay, with operative time generally comparable to OPN in experienced centers. Early and long-term renal function, measured by estimated glomerular filtration rate, was similar between approaches. Oncological outcomes, including positive surgical margins, recurrence-free survival, cancer-specific survival, and overall survival, were equivalent. In anatomically complex or selected T1b tumors, LPN achieved acceptable perioperative and oncological outcomes when performed in experienced centers. Conclusions: Laparoscopic partial nephrectomy is a safe and effective alternative to open surgery for localized renal tumors, offering perioperative benefits without compromising renal function or oncological control. Tumor complexity and patient characteristics are more influential determinants of outcomes than surgical approach. LPN should be considered a standard option in centers with expertise in minimally invasive nephron-sparing surgery.