Can partial nephrectomy preserve renal function and modify survival in comparison with radical nephrectomy?

Polo, J. Medina; Romero-Otero, Javier; Rodrı́guez-Antolı́n, A.; Domínguez-Esteban, M.; Passas-Martínez, J.B.; Villacampa, Felipe; Lora-Pablos, David; Cámara, Agustı́n Gómez de la; Díaz-González, Rafael

doi:10.3109/00365599.2010.548082

Cited by 29 publications

(24 citation statements)

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“…18,19,21,22,24,27,28,31,32,36,60,[86][87][88] Authors of studies with statistically significant OS advantage for PN acknowledged differences in baseline characteristics (ie selection bias) that may have contributed to the observed findings. 23,25,26,74 In 10 SEER studies comprising the majority of patients in this analysis PN was associated with a statistically significant overall survival benefit compared to RN for clinical stage T1a tumors but not for T1b tumors. 61,64,65,67,68,70,[83][84][85] Therefore, meta-analyses were different for SEER (effect size 1.23, range 1.13 to 1.33) and nonSEER studies (1.09, 0.88 to 1.34, supplementary table 9, fig.…”

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confidence: 91%

Management of Renal Masses and Localized Renal Cancer: Systematic Review and Meta-Analysis

et al. 2016

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Purpose-Several options exist for management of clinically localized renal masses suspicious for cancer, including active surveillance, thermal ablation and radical or partial nephrectomy. We summarize evidence on effectiveness and comparative effectiveness of these treatment approaches for patients with a renal mass suspicious for localized renal cell carcinoma. Materials and Methods-We searched MEDLINE®, Embase® and the Cochrane CentralRegister of Controlled Trials from January 1, 1997 through May 1, 2015. Paired investigators independently screened articles to identify controlled studies of management options or cohort studies of active surveillance, abstracted data sequentially and assessed risk of bias independently. Strength of evidence was graded by comparisons.Results-The search identified 107 studies (majority T1, no active surveillance or thermal ablation stratified outcomes of T2 tumors). Cancer specific survival was excellent among all management strategies (median 5-year survival 95%). Local recurrence-free survival was inferior for thermal ablation with 1 treatment but reached equivalence to other modalities after multiple treatments. Overall survival rates were similar among management strategies and varied with age and comorbidity. End-stage renal disease rates were low for all strategies (0.4% to 2.8%). Radical nephrectomy was associated with the largest decrease in estimated glomerular filtration rate and highest incidence of chronic kidney disease. Thermal ablation offered the most favorable perioperative outcomes. Partial nephrectomy showed the highest rates of urological complications but overall rates of minor/major complications were similar among interventions. Strength of evidence was moderate, low and insufficient for 11, 22 and 30 domains, respectively. * Correspondence: 600 N. Wolfe St., Park Building, Room 223, Baltimore, Maryland 21287 (telephone: 618-534-4942; FAX: 410-502-7711; hitenpatel@jhmi.edu). No direct or indirect commercial incentive associated with publishing this article.The corresponding author certifies that, when applicable, a statement(s) has been included in the manuscript documenting institutional review board, ethics committee or ethical review board study approval; principles of Helsinki Declaration were followed in lieu of formal ethics committee approval; institutional animal care and use committee approval; all human subjects provided written informed consent with guarantees of confidentiality; IRB approved protocol number; animal approved project number.References 51 through 88 can be obtained at http://jurology.com/. HHS Public Access METHODS Data Sources and SearchesWe report results from a broader systematic review. Data Synthesis and AnalysisAll studies were summarized qualitatively. LRFS was defined as the absence of any persistent or recurrent disease in the treated region of the kidney or associated renal fossa after a single, curative intent initial treatment. This definition included persistent enhancement of any treated mass, a visually e...

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Management of Renal Masses and Localized Renal Cancer: Systematic Review and Meta-Analysis

et al. 2016

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“…[1][2][3] More recently, however, larger studies comparing overall survival (OS) and CSS after partial and radical nephrectomies for T1b tumours have established NSS as an option with equivalent oncological outcomes and a significantly lower incidence of postoperative chronic kidney disease. [4][5][6][7][8][9][10][11] Based on these isolated studies, many medical associations (American Urological Association, European Association of Urology and the National Comprehensive Cancer Network) now recommend NSS for tumours larger than 4 cm which are surgically amendable to this approach.…”

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confidence: 99%

Oncological outcomes of partial nephrectomy for tumours larger than 4 cm: A systematic review

El-Ghazaly

Mason

Rendon

2014

CUAJ

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Introduction: Many medical associations recommend nephronsparing surgery (NSS) for tumours larger than 4 cm amenable to partial nephrectomy (PN). These recommendations are, however, mostly based on isolated reports. We systematically review the oncological outcomes of partial nephrectomy procedures performed for tumours larger than 4-cm. Methods: A PubMed search was carried out using keywords "partial nephrectomy" and "nephron sparing" for records dating back to 1995. In total, 2136 abstracts were analyzed; from these, 174 studies were scrutinized. We identified 32 manuscripts reporting size-specific cancer-specific survival rates for masses greater than 4 cm. From each of these studies, we recorded the number of PN, tumour diameter, follow-up duration, 5-and 10-year recurrence, overall and cancer-specific survival rates (OS, CSS). We also calculated weighted OS and CSS rates. Results: This systematic review includes 2445 patients with renal tumours larger than 4 cm who underwent PN: 1858 patients with tumours between 4 to 7 cm, 410 patients with tumours larger than 7 cm and 177 patients with tumours greater than 4 cm (exact size unknown). Our analysis revealed weighted 5-year CSS rates of 95.4%, 86.2% and 93.9% for tumours 4 to 7 cm, >7 cm, and all tumours >4 cm, respectively. The respective 5-year OS rates were 84.7%, 76.4%, and 84.7%. Conclusions: We found excellent 5-year CSS and OS rates for patients with tumours 4 to 7 cm treated with PN. These outcomes compare favourably to those reported in historical radical nephrectomy (RN) series for similarly sized tumours. Thus, PN is an acceptable and often preferred treatment for renal masses >4 cm which are amenable to nephron-sparing procedures.

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“…So far, most studies on PN have included only tumour, node, metastasis (TNM) stage I disease and have focused on survival and kidney function in a selected group of patients [15][16][17][18][19]. Furthermore, as most of these studies were carried out in large tertiary referral centres, the outcome may reflect that in a selected cohort of patients rather than in the general population.…”

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confidence: 99%

Kidney function following partial or radical nephrectomy for renal cell carcinoma: A population-based study

Mariusdottir

Jónsson

Marteinsson

et al. 2013

Scandinavian Journal of Urology

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Can partial nephrectomy preserve renal function and modify survival in comparison with radical nephrectomy?

Abstract: For stage T1 renal cortical tumours, NSS should, whenever possible, be regarded as the primary therapeutic option, given that it obtains similar oncological outcomes to RN and preserves renal function, which seems to translate into a lower overall mortality rate.

Cited by 29 publications

References 27 publications

Management of Renal Masses and Localized Renal Cancer: Systematic Review and Meta-Analysis

Management of Renal Masses and Localized Renal Cancer: Systematic Review and Meta-Analysis

Oncological outcomes of partial nephrectomy for tumours larger than 4 cm: A systematic review

Kidney function following partial or radical nephrectomy for renal cell carcinoma: A population-based study

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