• Logo
  • SBMUJournals

Partial Versus Radical Nephrectomy in Patients with Renal Cell Carcinoma: A Systematic Review and Meta-analysis

Yong Yang
133

Views


Abstract

Purpose: Radical nephrectomy (RN) and partial nephrectomy (PN) are widely used for early-stage renal cell carcinoma (RCC). However, the results were inconsistent while comparing the efficiency of RN and PN. This study aimed to assess the perioperative effectiveness of RN and PN for treating RCC.

Material and Methods: PubMed, Embase, and the Cochrane Library electronic database were searched for studies on adults with RCC comparing RN and PN published until September 2019. The perioperative efficacy and safety outcomes were calculated using odds ratio (OR) and standard mean difference (SMD) with 95% confidence intervals (CIs) for dichotomous and continuous data, respectively. Subgroup analysis were conducted based on tumor stage and surgery methods for evaluation of the treatment effect on specific subsets.

Results: A total of 23 studies involving 30,018 patients with RCC were included in this meta-analysis. Notably, RCC treated with PN was associated with low incidences of hospital mortality (OR: 0.58; 95% CI: 0.38–0.89; P = 0.013) and reoperation rate (OR: 0.74; 95% CI: 0.58–0.95; P = 0.016) as compared to RN. However, PN was associated with an increased risk of overall postoperative complications (OR: 1.40; 95% CI: 1.17–1.68, P < 0.001), postoperative hemorrhagic complications (OR: 1.92; 95% CI: 1.28–2.87, P = 0.002), and urinary fistula (OR: 17.65; 95% CI: 5.35–58.30, P < 0.001) as compared to RN.

Conclusion: These findings suggested that PN was associated with lower incidences of hospital mortality and reoperation rate, whereas RN was associated with fewer complications.



Keywords

meta-analysis; nephron-sparing surgery; radical nephrectomy; renal cell carcinoma; systematic review

References

Cuadros T, Trilla E, Sarro E, et al. HAVCR/KIM-1 activates the IL-6/STAT-3 pathway in clear cell renal cell carcinoma and determines tumor progression and patient outcome. Cancer Res. 2014;74:1416-28.

Djozic J, Djozic S, Bogdanovic J, et al. Preservation surgery in patients with localized renal cell cancer--nephron sparing surgery. Acta Chir Iugosl. 2014;61:45-9.

Marumo K, Kanayama H, Miyao N, et al. Prevalence of renal cell carcinoma: a nation-wide survey in Japan, 2002. Int J Urol. 2007;14:479-82.

Stafford HS, Saltzstein SL, Shimasaki S, Sanders C, Downs TM, Sadler GR. Racial/ethnic and gender disparities in renal cell carcinoma incidence and survival. J Urol. 2008;179:1704-8.

Macleod LC, Hotaling JM, Wright JL, et al. Risk factors for renal cell carcinoma in the VITAL study. J Urol. 2013;190:1657-61.

Grivas N, Kafarakis V, Tsimaris I, Raptis P, Hastazeris K, Stavropoulos NE. Clinico-pathological prognostic factors of renal cell carcinoma: A 15-year review from a single center in Greece. Urol Ann. 2014;6:116-21.

Sejima T, Iwamoto H, Masago T, et al. Oncological and functional outcomes after radical nephrectomy for renal cell carcinoma: a comprehensive analysis of prognostic factors. Int J Urol. 2013;20:382-9.

Lam JS, Bergman J, Breda A, Schulam PG. Importance of surgical margins in the management of renal cell carcinoma. Nat Clin Pract Urol. 2008;5:308-17.

Ono Y, Hattori R, Gotoh M, Yoshino Y, Yoshikawa Y, Kamihira O. Laparoscopic radical nephrectomy for renal cell carcinoma: the standard of care already? Curr Opin Urol. 2005;15:75-8.

Shuch B, Lam JS, Belldegrun AS. Open partial nephrectomy for the treatment of renal cell carcinoma. Curr Urol Rep. 2006;7:31-8.

Borin JF. Laparoscopic radical nephrectomy: long-term outcomes. Curr Opin Urol. 2008;18:139-44.

Park SW, Jung SG, Lee W, Chung MK. Changes in renal function after nephron-sparing surgery in patients with a normal contralateral kidney. Int J Urol. 2010;17:457-61.

Whitson JM, Harris CR, Meng MV. Population-based comparative effectiveness of nephron-sparing surgery vs ablation for small renal masses. BJU Int. 2012;110:1438-43; discussion 43.

Motzer RJ, Agarwal N, Beard C, et al. NCCN clinical practice guidelines in oncology: kidney cancer. J Natl Compr Canc Netw. 2009;7:618-30.

Terrone C, Volpe A. Can emerging level 1 evidence "discourage" elective nephron-sparing surgery for small renal tumors? Eur Urol. 2011;59:553-5.

Joniau S, Vander Eeckt K, Srirangam SJ, Van Poppel H. Outcome of nephron-sparing surgery for T1b renal cell carcinoma. BJU Int. 2009;103:1344-8.

Ljungberg B, Bensalah K, Canfield S, et al. EAU guidelines on renal cell carcinoma: 2014 update. Eur Urol. 2015;67:913-24.

Ljungberg B, Hanbury DC, Kuczyk MA, et al. Renal cell carcinoma guideline. Eur Urol. 2007;51:1502-10.

Kim SP, Thompson RH, Boorjian SA, et al. Comparative effectiveness for survival and renal function of partial and radical nephrectomy for localized renal tumors: a systematic review and meta-analysis. J Urol. 2012;188:51-7.

MacLennan S, Imamura M, Lapitan MC, et al. Systematic review of perioperative and quality-of-life outcomes following surgical management of localised renal cancer. Eur Urol. 2012;62:1097-117.

MacLennan S, Imamura M, Lapitan MC, et al. Systematic review of oncological outcomes following surgical management of localised renal cancer. Eur Urol. 2012;61:972-93.

Tobert CM, Riedinger CB, Lane BR. Do we know (or just believe) that partial nephrectomy leads to better survival than radical nephrectomy for renal cancer? World J Urol. 2014;32:573-9.

Nabi G, Cleves A, Shelley M. Surgical management of localised renal cell carcinoma. Cochrane Database Syst Rev. 2010CD006579.

Manikandan R, Srinivasan V, Rane A. Which is the real gold standard for small-volume renal tumors? Radical nephrectomy versus nephron-sparing surgery. J Endourol. 2004;18:39-44.

Moher D, Liberati A, Tetzlaff J, Altman DG, Group P. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA Statement. Open Med. 2009;3:e123-30.

Koning GG, Wetterslev J, van Laarhoven CJ, Keus F. The totally extraperitoneal method versus Lichtenstein's technique for inguinal hernia repair: a systematic review with meta-analyses and trial sequential analyses of randomized clinical trials. PLoS One. 2013;8:e52599.

Keus F, Gooszen HG, van Laarhoven CJ. Open, small-incision, or laparoscopic cholecystectomy for patients with symptomatic cholecystolithiasis. An overview of Cochrane Hepato-Biliary Group reviews. Cochrane Database Syst Rev. 2010CD008318.

Higgins J, Green S. Cochrane Handbook for systematic reviews of interventions version 5.1.0. Cochrane handbook; 2011.

Gopalakrishna G, Mustafa RA, Davenport C, et al. Applying Grading of Recommendations Assessment, Development and Evaluation (GRADE) to diagnostic tests was challenging but doable. J Clin Epidemiol. 2014;67:760-8.

Xu X, Li X, Liu L, Wu W. A meta-analysis of external fixator versus intramedullary nails for open tibial fracture fixation. J Orthop Surg Res. 2014;9:75.

Wang Y, Zhang FC, Wang YJ. Helicobacter pylori and pancreatic cancer risk: a meta- analysis based on 2,049 cases and 2,861 controls. Asian Pac J Cancer Prev. 2014;15:4449-54.

Begg CB, Mazumdar M. Operating characteristics of a rank correlation test for publication bias. Biometrics. 1994;50:1088-101.

Egger M, Davey Smith G, Schneider M, Minder C. Bias in meta-analysis detected by a simple, graphical test. BMJ. 1997;315:629-34.

Papageorgiou SN, Dimitraki D, Coolidge T, Kotsanos N. Publication bias & small-study effects in pediatric dentistry meta-analyses. J Evid Based Dent Pract. 2015;15:8-24.

Duval S, Tweedie R. Trim and fill: A simple funnel-plot-based method of testing and adjusting for publication bias in meta-analysis. Biometrics. 2000;56:455-63.

Butler BP, Novick AC, Miller DP, Campbell SA, Licht MR. Management of small unilateral renal cell carcinomas: radical versus nephron-sparing surgery. Urology. 1995;45:34-40; discussion -1.

Indudhara R, Bueschen AJ, Urban DA, Burns JR, Lloyd LK. Nephron-sparing surgery compared with radical nephrectomy for renal tumors: current indications and results. South Med J. 1997;90:982-5.

Uzzo RG, Wei JT, Hafez K, Kay R, Novick AC. Comparison of direct hospital costs and length of stay for radical nephrectomy versus nephron-sparing surgery in the management of localized renal cell carcinoma. Urology. 1999;54:994-8.

Corman JM, Penson DF, Hur K, et al. Comparison of complications after radical and partial nephrectomy: results from the National Veterans Administration Surgical Quality Improvement Program. BJU Int. 2000;86:782-9.

Shekarriz B, Upadhyay J, Shekarriz H, et al. Comparison of costs and complications of radical and partial nephrectomy for treatment of localized renal cell carcinoma. Urology. 2002;59:211-5.

Kim FJ, Rha KH, Hernandez F, Jarrett TW, Pinto PA, Kavoussi LR. Laparoscopic radical versus partial nephrectomy: assessment of complications. J Urol. 2003;170:408-11.

Stephenson AJ, Hakimi AA, Snyder ME, Russo P. Complications of radical and partial nephrectomy in a large contemporary cohort. J Urol. 2004;171:130-4.

Van Poppel H, Da Pozzo L, Albrecht W, et al. A prospective randomized EORTC intergroup phase 3 study comparing the complications of elective nephron-sparing surgery and radical nephrectomy for low-stage renal cell carcinoma. Eur Urol. 2007;51:1606-15.

Miller DC, Schonlau M, Litwin MS, Lai J, Saigal CS, Urologic Diseases in America P. Renal and cardiovascular morbidity after partial or radical nephrectomy. Cancer. 2008;112:511-20.

Gratzke C, Seitz M, Bayrle F, et al. Quality of life and perioperative outcomes after retroperitoneoscopic radical nephrectomy (RN), open RN and nephron-sparing surgery in patients with renal cell carcinoma. BJU Int. 2009;104:470-5.

Simmons MN, Weight CJ, Gill IS. Laparoscopic radical versus partial nephrectomy for tumors >4 cm: intermediate-term oncologic and functional outcomes. Urology. 2009;73:1077-82.

Roos FC, Brenner W, Jager W, et al. Perioperative morbidity and renal function in young and elderly patients undergoing elective nephron-sparing surgery or radical nephrectomy for renal tumours larger than 4 cm. BJU Int. 2011;107:554-61.

Lowrance WT, Yee DS, Savage C, et al. Complications after radical and partial nephrectomy as a function of age. J Urol. 2010;183:1725-30.

Sun M, Bianchi M, Hansen J, et al. Chronic kidney disease after nephrectomy in patients with small renal masses: a retrospective observational analysis. Eur Urol. 2012;62:696-703.

Becker A, Ravi P, Roghmann F, et al. Laparoscopic radical nephrectomy vs laparoscopic or open partial nephrectomy for T1 renal cell carcinoma: comparison of complication rates in elderly patients during the initial phase of adoption. Urology. 2014;83:1285-91.

Liu JJ, Leppert JT, Maxwell BG, Panousis P, Chung BI. Trends and perioperative outcomes for laparoscopic and robotic nephrectomy using the National Surgical Quality Improvement Program (NSQIP) database. Urol Oncol. 2014;32:473-9.

Hadjipavlou M, Khan F, Fowler S, et al. Partial vs radical nephrectomy for T1 renal tumours: an analysis from the British Association of Urological Surgeons Nephrectomy Audit. BJU Int. 2016;117:62-71.

Hasan WA, Abreu SC, Gill IS. Laparoscopic surgery for renal cell carcinoma. Expert Rev Anticancer Ther. 2003;3:830-6.

Breda A, Finelli A, Janetschek G, Porpiglia F, Montorsi F. Complications of laparoscopic surgery for renal masses: prevention, management, and comparison with the open experience. Eur Urol. 2009;55:836-50.

Ghoneim IA, Fergany AF. Minimally invasive surgery for renal cell carcinoma. Expert Rev Anticancer Ther. 2009;9:989-97.




DOI: http://dx.doi.org/10.22037/uj.v0i0.5358

Refbacks

  • There are currently no refbacks.