Chinese expert consensus on robot-assisted laparoscopic partial nephrectomy
Year: 2026
Type: article
Abstract: Background: Robot-assisted laparoscopic partial nephrectomy (RAPN) is an important nephron-sparing surgical approach for localized renal tumors. With continuous technical maturation, the indications for RAPN have expanded to hilar renal tumors, endophytic tumors, solitary kidney, multiple or bilateral renal tumors, and selected T2 renal tumors. However, partial nephrectomy (PN) carries a relatively high perioperative risk and therefore requires cautious implementation and standardized dissemination. This international expert consensus aims to promote standardized, homogeneous, and safe implementation of RAPN. Methods: This international expert consensus was developed using a key clinical question-based approach. PubMed, Embase, the Cochrane Library, and China National Knowledge Infrastructure were systematically searched through May 2026 for relevant guidelines, systematic reviews and meta-analyses, randomized controlled trials, cohort studies, and high-quality retrospective studies. Core clinical questions were identified and refined through expert discussion. Recommendations were subsequently formulated through a Delphi process and expert consensus meeting. The certainty of evidence and strength of recommendations were assessed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. Recommendation development followed the GRADE-ADOLOPMENT (Adoption, Adaptation, and De Novo Development) framework, incorporating adoption or adaptation of existing guideline recommendations and de novo development when appropriate. A three-round Delphi process was used to achieve expert consensus. Results: Ten key clinical questions were addressed, covering preoperative evaluation, indications and contraindications, selection of transperitoneal or retroperitoneal approaches, renal vascular control, renal parenchymal reconstruction, preservation of renal function, prevention and management of perioperative complications, postoperative follow-up, management of positive surgical margins, and RAPN strategies for patients with solitary kidneys, bilateral or multiple renal tumors, or hereditary renal cancer. The recommendations emphasize comprehensive preoperative assessment, individualized surgical planning, appropriate vascular control and renorrhaphy, maximal preservation of functional renal parenchyma, standardized complication management, risk-adapted follow-up, and judicious application of RAPN in complex renal tumors. Conclusions: RAPN should be performed according to individualized patient and tumor characteristics, with oncological control, perioperative safety, and preservation of renal function as the principal therapeutic goals. This consensus provides a structured framework for the standardized and safe implementation of RAPN and may facilitate consistent clinical decision-making and quality improvement across centers.
Language: English
Subfield: Oncology
Field: Medicine
Domain: Health Sciences
Open Access status: diamond
OpenAlex ID: W7223555389