MP75-18 PARTIAL NEPHRECTOMY VERSUS RADICAL NEPHRECTOMY FOR CLINICAL T1B AND T2 RENAL MASS: A META-ANALYSIS OF OVER 9000 CASES

Abstract

You have accessJournal of UrologyKidney Cancer: Localized: Surgical Therapy V1 Apr 2016MP75-18 PARTIAL NEPHRECTOMY VERSUS RADICAL NEPHRECTOMY FOR CLINICAL T1B AND T2 RENAL MASS: A META-ANALYSIS OF OVER 9000 CASES Maria Carmen Mir, Ithaar Derweesh, Francesco Porpiglia, Alessandro Volpe, Giacomo Novara, Vincenzo Ficarra, Nicola Pavan, Humberto Laydner, Jihad Kaouk, Homi Zargar, and Riccardo Autorino Maria Carmen MirMaria Carmen Mir More articles by this author , Ithaar DerweeshIthaar Derweesh More articles by this author , Francesco PorpigliaFrancesco Porpiglia More articles by this author , Alessandro VolpeAlessandro Volpe More articles by this author , Giacomo NovaraGiacomo Novara More articles by this author , Vincenzo FicarraVincenzo Ficarra More articles by this author , Nicola PavanNicola Pavan More articles by this author , Humberto LaydnerHumberto Laydner More articles by this author , Jihad KaoukJihad Kaouk More articles by this author , Homi ZargarHomi Zargar More articles by this author , and Riccardo AutorinoRiccardo Autorino More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2016.02.1736AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Partial nephrectomy (PN) is the reference standard of management for cT1a (<4 cm) renal mass. However, its role in the management of larger tumors is still debated. We performed a meta-analysis of studies comparing radical nephrectomy (RN) to PN for cT1b and T2 renal mass. METHODS A systematic literature review was performed to identify pertinent studies published up to October 2015. PRISMA criteria were followed for article selection. Odds ratio (OR) was used for all binary variables, and weight mean difference (WMD) was used for the continuous parameters. Pooled estimates were calculated with fixed-effect model, if no significant heterogeneity was identified; alternatively, the random-effect model was used when significant heterogeneity was detected. Demographics, surgical, functional and oncological outcomes were compared between RN and PN. Sensitivity analysis was performed for studies related to cT2 (> 7 cm) tumors. RESULTS Twenty-two retrospective case-control studies including 9525 patients (RN=7269; PN=2256) were deemed eligible and included in the analysis. Patients undergoing PN were younger (WMD: 2.3 years; p<0.001), and with smaller masses (WMD: -0.65 cm, p<0.001), whereas there was no difference for the baseline renal function. RN was favored for shorter operative time (WMD: 17.7 min; p<0.001), lower estimated blood loss (WMD: -102.6; p<0.001), and lower odds of postoperative complications (OR: 1.74; p<0.001). PN was associated with improved preservation of renal function, as shown by higher postoperative eGFR (WMD: 12.4 ml/min; p<0.001) and lower postoperative onset of CKD (OR: 0.36; p<0.001). Likelihood of tumor recurrence was lower for PN (OR: 0.6; p<0.001), as well as cancer-specific (OR: 0.58; p=0.001) and all-cause mortality (OR: 0.67; p=0.005). A sensitivity analysis was performed for 4 available studies on T2 (> 7 cm) tumors (n=2004). Also in this subgroup, tumor size was smaller for PN (WMD: 1.8 cm; p=0.02). Also, higher estimated blood loss was found for PN (WMD: 107.6 m; p<0.001), as well as a higher likelihood of complications (OR: 2.5; p<0.001). Higher recurrence rate (OR: 0.52; p=0.003), and a higher cancer specific mortality (OR: 0.59; p=0.03) was recorded for RN group for cT2 only. Difference in tumor size between the study group is indicative of a selection bias in this metaanalysis of retrospective studies. CONCLUSIONS Current evidence suggests that PN does not compromise oncologic outcomes in larger tumors, and it may be associated with improved renal functional preservation, despite a higher risk of surgery-related complications. © 2016FiguresReferencesRelatedDetails Volume 195Issue 4SApril 2016Page: e985-e986 Advertisement Copyright & Permissions© 2016MetricsAuthor Information Maria Carmen Mir More articles by this author Ithaar Derweesh More articles by this author Francesco Porpiglia More articles by this author Alessandro Volpe More articles by this author Giacomo Novara More articles by this author Vincenzo Ficarra More articles by this author Nicola Pavan More articles by this author Humberto Laydner More articles by this author Jihad Kaouk More articles by this author Homi Zargar More articles by this author Riccardo Autorino More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...