Renal Functional Outcomes after Surgery, Ablation, and Active Surveillance of Localized Renal Tumors: A Systematic Review and Meta-Analysis

Abstract

Renal functional implications varied across management strategies for localized renal masses, with worse postoperative renal function for patients undergoing radical nephrectomy compared with other strategies and similar outcomes for partial nephrectomy and thermal ablation. Further attention is needed to quantify the changes in renal function associated with active surveillance and nephron-sparing approaches for patients with preexisting CKD.

Comparative effectiveness of management options for patients with small renal masses: a prospective cohort study

“…In the meta‐analysis, no differences in renal function were found between PN and ablation patients, but data were insufficient to compare either intervention against the AS group . Results from the present study corroborate these retrospective findings in a prospective cohort but also provide insight into direct comparisons of renal function to AS, which was previously found not to preserve eGFR any better than PN or ablation .…”

Pooled analysis of stereotactic ablative radiotherapy for primary renal cell carcinoma: A report from the International Radiosurgery Oncology Consortium for Kidney (IROCK)

“…Renal dysfunction after thermal ablation is proportional to the greatest tumor dimension and the volume of ablation zones, with most ablated tumors in the literature ranging in size from 2 to 3 cm in greatest dimension. In a recent systematic review and meta‐analysis of 18 studies comparing changes in eGFR after partial nephrectomy versus thermal ablation for small renal masses, mean GFR losses of −6.2 mL per minute and −4.5 mL per minute, respectively, were observed for each modality . The results from the current cohort of patients who received SABR for T1a disease are comparable (−4.0 mL per minute) to these other modalities, although many patients had pre‐existing renal dysfunction.…”

Outcome Measures Used to Report Kidney Function in Studies Investigating Surgical Management of Kidney Tumours: A Systematic Review

“…One important aspect, which was not a prespecified aim of this review, was evaluating the minimum follow-up time for outcome reporting. In a recent systematic review, Patel et al [61] reported that a level of functional recovery could be expected after 6 mo following nephrectomy, and in a recent population-based study of 14 129 American patients, Leppert et al [62] found that the median time to stage 4 or higher CKD was 5 mo after nephrectomy, with 75% of events occurring within 9 mo. In the absence of more robust data, it is reasonable to consider 6 mo as a minimum time to followup when evaluating absolute postoperative eGFR in nephrectomy patients, and 9 mo when considering postoperative CKD.…”