Abstract
ObjectiveThe choice of surgical method for clinically diagnosed T2 or higher stage kidney cancer remains controversial. Here, we systematically reviewed and collected published comparative studies on renal function, oncologic outcomes, and perioperative results of partial nephrectomy (PN) versus radical nephrectomy (RN) for larger renal tumors (T2 and above), and performed a meta-analysis.Evidence AcquisitionFollowing searches of PubMed, Web of Science, and Embase, the original studies on PN vs. RN in the treatment of T2 renal cancer were screened through strict inclusion and exclusion criteria. RevMan 5.4 was used for data analysis of the perioperative results, renal function, and oncologic outcomes of the two surgical methods for T2 renal tumor therapy. The weighted mean difference was used as the combined effect size for continuous variables, while the odds ratio (OR) or risk ratio (RR) was used as the combined effect size for binary variables. Both variables used a 95% confidence interval (CI) to estimate statistical accuracy. In cases with low heterogeneity, the fixed-effects model was used to pool the estimated value; otherwise, the random-effects model was used when significant heterogeneity was detected.ResultsFifteen retrospective studies including 5,056 patients who underwent nephrectomy (PN: 1975, RN: 3081) were included. The decline in estimated GFR (eGFR) after PN was lower than RN [(MD: −11.74 ml/min/1.73 m2; 95% CI: −13.15, −10.32; p < 0.00001)]. The postoperative complication rate of PN was higher than that of PN (OR: 2.09; 95% CI: 1.56, 2.80; p < 0.00001)], and the postoperative overall survival (OS) of PN was higher than that of RN (HR: 0.77; 95% CI: 0.65, 0.90; p = 0.002), and tumor recurrence (RR, 0.69; 95% CI: 0.53, 0.90; p = 0.007). No obvious publication bias was found in the funnel chart of the OS rates of the two groups of patients.ConclusionsPN is beneficial for patients with T2 renal tumors in terms of OS and renal function protection. However, it is also associated with a higher risk of surgical complications.
Highlights
Kidney cancer is a common tumor in the urinary system
Original articles that met the following criteria were considered for inclusion: Original articles that involved studying the efficacy of partial nephrectomy (PN) vs. radical nephrectomy (RN) in the treatment of T2 renal tumors, or some subgroups; publications written in the English language; studies in which the patients undergoing nephrectomy were all adults (> 18 years old); both retrospective and prospective studies; studies meeting at least one of the required outcome indicators for this study
All steps were based on the meta-analysis of the PRISMA statement flow chart (Figure 1), and a comprehensive evaluation and data extraction was performed for the remaining articles
Summary
According to the EAU Urology Kidney Cancer Diagnosis and Treatment Guidelines updated in 2014, radical nephrectomy (RN) should be performed for renal tumors of clinical T staging T2, or in patients with localized renal tumors that cannot be treated with nephron preservation [1]. For patients with localized T1a-b renal tumors, both partial nephrectomy (PN) and RN have been shown to have similar oncological effects. Regardless of whether artificially-assisted laparoscopic or robot-assisted laparoscopic PN, PN is regarded as the best choice for the treatment of T1 renal tumors. It has been reported that the 10-year overall survival (OS) rate of patients with T1 stage renal tumors who underwent laparoscopic or open partial nephrectomy was associated with the patient’s age, comorbidities, surgical indications, and other factors, as well as the prediction of cancer-free survival rate, but not the surgical method itself. The choice of surgical method depends only on the surgeon’s preference and experience [2]
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
