Partial Nephrectomy Versus Radical Nephrectomy for Clinical T2 or Higher Stage Renal Tumors: A Systematic Review and Meta-Analysis

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.

Partial Nephrectomy for T1b/T2 Renal Mass

“…PN has been shown to benefit patients with T2 renal tumors in terms of survival and renal function protection ( 14 ). Overall and RCC-specific 5- and 10-year survival rates after PN have been reported to be 94.5 and 70.9%, respectively ( 5 ).…”

“…The decline in eGFR after PN was less than that after RN. Subsequently, PN has been shown to benefit patients with T2 renal tumors in terms of renal function protection ( 14 ).…”

Treatment strategies for clear cell renal cell carcinoma: Past, present and future

“…NSS only removes part of the diseased kidney tissue, preserving as much of the ipsilateral normal kidney unit as possible. Nevertheless, NSS is a long procedure and is prone to common complications such as hematuria, perirenal hematoma, and urinary fistula ( 3 , 9 ). As long as it is technically feasible, the guidelines recommend prioritizing NSS for patients with T1 and T2 ( 10 ).…”

Renal function assessment after embolization of vascular complications following partial nephrectomy

“…Although PN is typically associated with a higher risk of complications than radical nephrectomy [4], the overall risk of any-grade and high-grade peri-operative complications is acceptably low (approximately 20% and 5%, respectively) [3]. One of the most severe and life-threatening complications of such procedures is the occurrence of iatrogenic vascular lesions, including pseudoaneurysm (PA) and arteriovenous fistula (AVF).…”