Partial nephrectomy versus radical nephrectomy for cT2 or greater renal tumors: a systematic review and meta-analysis

Li, Jingdong; Zhang, Yanping; Teng, Zhihai; Han, Zhenwei

doi:10.23736/s0393-2249.19.03470-2

Cited by 33 publications

(19 citation statements)

References 45 publications

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“…Mir et al . summarized the available literature in two separate meta‐analyses comparing PN and RN in renal masses >7 cm 4,5 . They both concluded PN has comparable oncologic outcomes with superior preservation of renal function, but higher postoperative morbidity, as compared with RN.…”

Section: Introductionmentioning

confidence: 99%

Partial versus radical nephrectomy in clinical T2 renal masses

et al. 2021

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Objective To report perioperative, renal functional and oncologic outcomes for patients undergoing partial or radical nephrectomy for cT2 renal masses. Methods Retrospective review of patients who underwent partial (n = 72) or radical nephrectomy (n = 379) for cT2 renal masses from 2000 to 2016. After propensity adjustment using inverse probability weighting, the following were compared by surgery (partial or radical nephrectomy): complications, renal function measured by estimated glomerular filtration rate as continuous and as <60 mL/min/1.73 m2 at 1 and 3 years postoperatively and overall, metastases‐free survival and cancer‐specific survival in patients with renal cell carcinoma. Results After propensity adjustment, clinical and radiographic features were well‐balanced between groups. Overall and severe complications were more common for partial compared with radical nephrectomy, although not statistically significant (19 vs 13%, P = 0.14 and 4 vs 2%, P = 0.3, respectively). Estimated glomerular filtration rate change at 1 and 3 years was more pronounced in radical compared with partial nephrectomy (median −16 vs −5 and −14 vs −2, respectively, P < 0.001). A greater proportion of radical nephrectomy patients had an estimated glomerular filtration rate <60 at 1 and 3 years (55 vs 17% and 48 vs 17%, respectively, P < 0.01). In renal cell carcinoma patients, overall, metastases‐free and cancer‐specific survival were not significantly different between groups (median survivor follow up 7.1 years, interquartile range 3.6–11.4). Conclusions Partial nephrectomy appears to be a relatively safe and a potentially effective treatment for cT2 renal masses, conferring better renal functional preservation compared with radical nephrectomy. These data support continued use of partial nephrectomy for renal masses >7 cm in appropriately selected patients.

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Section: Introductionmentioning

confidence: 99%

Partial versus radical nephrectomy in clinical T2 renal masses

et al. 2021

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“…Alongside with this occurrence, kidney surgery has undergone both theoretical and technical developments [ 2 , 3 ]. Firstly, the indication for partial nephrectomy (PN) in elective cases has been expanded widely, being well demonstrated the advantages of partial over radical surgery in T1 tumors in terms of functional preservation with similar oncological safety [ 4 – 6 ]. On the other hand, the technological improvements of the last 30 years paved the way for the gradually increased employment of minimally invasive approaches, first with the advent of laparoscopy and then with robotics, progressively minimizing the impact and invasiveness of surgical procedures [ 7 – 9 ].…”

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confidence: 99%

Transperitoneal vs retroperitoneal minimally invasive partial nephrectomy: comparison of perioperative outcomes and functional follow-up in a large multi-institutional cohort (The RECORD 2 Project)

et al. 2020

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Background Aim of this study was to evaluate and compare perioperative outcomes of transperitoneal (TP) and retroperitoneal (TR) approaches in a multi-institutional cohort of minimally invasive partial nephrectomy (MI-PN). Material and methods All consecutive patients undergone MI-PN for clinical T1 renal tumors at 26 Italian centers (RECORd2 project) between 01/2013 and 12/2016 were evaluated, collecting the pre-, intra-, and postoperative data. The patients were then stratified according to the surgical approach, TP or RP. A 1:1 propensity score (PS) matching was performed to obtain homogeneous cohorts, considering the age, gender, baseline eGFR, surgical indication, clinical diameter, and PADUA score. Results 1669 patients treated with MI-PN were included in the study, 1256 and 413 undergoing TP and RP, respectively. After 1:1 PS matching according to the surgical access, 413 patients were selected from TP group to be compared with the 413 RP patients. Concerning intraoperative variables, no differences were found between the two groups in terms of surgical approach (lap/robot), extirpative technique (enucleation vs standard PN), hilar clamping, and ischemia time. Conversely, the TP group recorded a shorter median operative time in comparison with the RP group (115 vs 150 min), with a higher occurrence of intraoperative overall, 21 (5.0%) vs 9 (2.1%); p = 0.03, and surgical complications, 18 (4.3%) vs 7 (1.7%); p = 0.04. Concerning postoperative variables, the two groups resulted comparable in terms of complications, positive surgical margins and renal function, even if the RP group recorded a shorter median drainage duration and hospital length of stay (3 vs 2 for both variables), p < 0.0001. Conclusions The results of this study suggest that both TP and RP are feasible approaches when performing MI-PN, irrespectively from tumor location or surgical complexity. Notwithstanding longer operative times, RP seems to have a slighter intraoperative complication rate with earlier postoperative recovery when compared with TP.

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“…Historically, radical nephrectomy (RN) has been the benchmark surgical treatment of organ-confined RCC. Partial nephrectomy (PN) has taken over primacy in treatment of RCC up to 4 cm and in selected cases with tumours from 4 to 7 cm has proven to be as reliable as radical nephrectomy 6 , though now there are guidelines available that recommend that PN can be applied even in tumours that exceed 7 cm 7 . So far, a unified and definitive position on the role of PN in clinical-stage T1bN0M0 has not been proposed, when there is no absolute indication for this type of surgery.…”

Section: Introductionmentioning

confidence: 99%

Comparison of oncologic outcomes between elective partial and radical nephrectomy in patients with renal cell carcinoma in CT1B stadium

et al. 2022

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Background/Aim. In renal cell carcinoma (RCC) the choice of surgical technique, radical (RN) or partial nephrectomy (PN) is still centre dependant because there still are no absolute recommendations for this approach. This study aims to analyze the oncological aspects, time until recurrent disease appears and cancer-specific survival in patients with RCC in T1bN0?0 depending on the type of surgical procedure partial or radical nephrectomy. Methods. A clinical observational study of a series of cases was conducted that analyzed data of 154 patients operated in our institution with a mean follow up a period not less than five years. The inclusion criteria included: renal tumours 4-7 cm, histopathological confirmation of RCC, absence of metastasis and normal serum creatinine. Exclusion criteria included: the presence of other malignancies, solitary functional kidney or comorbidities that can compromise renal function, bilateral tumours or unilateral multiple tumours. Results. The study analyzed data of 154 patients, 97 radical nephrectomies and 57 patients that underwent partial nephrectomy. Analyzing cancer-specific survival in four patients with RN there was a disease advancement that led to a lethal outcome, one PN patient died as a result of local relapse and distant metastasis. Conclusion. Based on our results PN is a good and safe treatment option for patients with RCC in T1b stadium. Partial nephrectomy offers a similar tumour control and better cancer-specific survival.

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Partial nephrectomy versus radical nephrectomy for cT2 or greater renal tumors: a systematic review and meta-analysis

Cited by 33 publications

References 45 publications

Partial versus radical nephrectomy in clinical T2 renal masses

Partial versus radical nephrectomy in clinical T2 renal masses

Transperitoneal vs retroperitoneal minimally invasive partial nephrectomy: comparison of perioperative outcomes and functional follow-up in a large multi-institutional cohort (The RECORD 2 Project)

Comparison of oncologic outcomes between elective partial and radical nephrectomy in patients with renal cell carcinoma in CT1B stadium

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