Comparison of the long-term follow-up and perioperative outcomes of partial nephrectomy and radical nephrectomy for 4 cm to 7 cm renal cell carcinoma: a systematic review and meta-analysis

Abstract

Background The efficacy of partial nephrectomy (PN) for T1b renal cell carcinoma (RCC) is controversial. The oncological outcomes, the change in postoperative renal function and the perioperative complications are unclear. Methods We searched PUBMED, EMBASE and the Cochrane Central Register for studies from March 1998 to March 2018 for studies comparing PN to radical nephrectomy (RN) for the treatment of T1b RCC. After data extraction and quality assessment, we used RevMan 5.2 to pool the data. Then, we used Stata 12.0 to perform sensitivity analyses and meta-regression. We used the GRADE profiler to evaluate the evidence according to the GRADE approach. Results A total of 16 studies involving 33,117 patients were included in our meta-analysis. No significant difference was found in the 5-year overall survival (OS), 10-year OS, 5-year recurrence-free survival (RFS) and 10-year RFS. The 5-year cancer-special survival (CSS) and 10-year CSS were better in RN compared to PN, respectively, at RR = 1.02, P < 0.05 and RR = 1.04, P < 0.05. PN was better than RN in the preservation of renal function (WMD = -9.15, 95% CI: − 10.30 to − 7.99, P < 0.05). The confidence level grading of the evidence was moderate for 5-year OS, 10-year OS, 5-year CSS, 10-year CSS, 5-year RFS, 10-year RFS, tumor recurrence, decline in eGFR, and postoperative complications. Conclusions PN may provide comparable outcomes in terms of RFS & OS, and better renal function preservation although CSS was worse. Electronic supplementary material The online version of this article (10.1186/s12894-019-0480-6) contains supplementary material, which is available to authorized users.

Local recurrence and other oncologic outcomes after percutaneous image-guided tumor ablations on stageT1b renal cell carcinoma: a systematic review and network meta-analysis

“…Overall, this analysis shows that mean follow-up after percutaneous ablation was shorter compared to surgery cohorts [32]. It is to be noted that in Matin et al's study on local tumor progression following RFA or CA for kidney tumors, it was found that in most cases (69.8%) disease was detected within the first 3 months of surveillance imaging and the majority (92.1%) within the first 12 months, with a few cases detected after 1 year [41].…”

“…Katsanos [33] meta-analysis about TA of smaller renal tumors (mean size 2.5cm) found a 7.4% prevalence of adverse effects and 2.3% prevalence of major adverse effects. In a recent cohort study on cT1b tumors treated by surgery, Jiang et al found a complication rate of 26% for PN and 14% for RN [32]. No statistical differences were found between RN and PN.…”

“…In their meta-analysis on T1b, Jiang et al found no statistically different complication rates between RN and PN (14% for RN and 25% for PN) [32]. Concerning eGFR decrease, results varied from a mean decrease of 27% after RFA (Hasegawa [8]) (11% in CA) to no modification in Gunn et al [17].…”

Should patients with low‐risk renal cell carcinoma be followed differently after nephron‐sparing surgery vs radical nephrectomy?

“…Interestingly, the definition of low-risk disease varies among guidelines. While the surveillance protocol proposed by the EAU takes into account patients' risk profile assessed with one of the validated risk models [2,11], the NCCN and AUA guidelines recommend that patients be stratified by TNM staging alone. Furthermore, the AUA also offers different patterns of surveillance according to the treatment received (RN, PN or ablation therapy) [9].…”

Laparoscopic enucleation of renal masses

“…RN could accelerate the loss of kidney function, affect the quality of life and lead to death, particularly in the elderly, who could also suffer from other diseases that lead to CKD. (4,5) These are the reasons why, nowadays, nephron-sparing surgery (NSS) is the standard treatment for stage cT1 renal tumors, provided that it is technically possible; the indications for NSS have been extended even to stage cT2. (4,6) When NSS emerged, the prevailing criterion was that the resection of the tumor should be performed with a wide margin of normal renal parenchyma to minimize the risk of local recurrences.…”