Advertisement
You are prohibited from using or uploading content you accessed through this website into external applications, bots, software, or websites, including those using artificial intelligence technologies and infrastructure, including deep learning, machine learning and large language models and generative AI.
No AccessJournal of UrologyAdult Urology1 Jul 2012

Comparative Effectiveness for Survival and Renal Function of Partial and Radical Nephrectomy for Localized Renal Tumors: A Systematic Review and Meta-Analysis

    View All Author Information

    Purpose:

    The relative effectiveness of partial vs radical nephrectomy remains unclear in light of the recent phase 3 European Organization for the Research and Treatment of Cancer trial. We performed a systematic review and meta-analysis of partial vs radical nephrectomy for localized renal tumors, considering all cause and cancer specific mortality, and severe chronic kidney disease.

    Materials and Methods:

    Cochrane Central Register of Controlled Trials, MEDLINE®, EMBASE®, Scopus and Web of Science® were searched for sporadic renal tumors that were surgically treated with partial or radical nephrectomy. Generic inverse variance with fixed effects models were used to determine the pooled HR for each outcome.

    Results:

    Data from 21, 21 and 9 studies were pooled for all cause and cancer specific mortality, and severe chronic kidney disease, respectively. Overall 31,729 (77%) and 9,281 patients (23%) underwent radical and partial nephrectomy, respectively. According to pooled estimates partial nephrectomy correlated with a 19% risk reduction in all cause mortality (HR 0.81, p <0.0001), a 29% risk reduction in cancer specific mortality (HR 0.71, p = 0.0002) and a 61% risk reduction in severe chronic kidney disease (HR 0.39, p <0.0001). However, the pooled estimate of cancer specific mortality for partial nephrectomy was limited by the lack of robustness in consistent findings on sensitivity and subgroup analyses.

    Conclusions:

    Our findings suggest that partial nephrectomy confers a survival advantage and a lower risk of severe chronic kidney disease after surgery for localized renal tumors. However, the results should be evaluated in the context of the low quality of the existing evidence and the significant heterogeneity across studies. Future research should use higher quality evidence to clearly demonstrate that partial nephrectomy confers superior survival and renal function.

    References

    • 1 : Cancer statistics, 2010. CA Cancer J Clin2010; 60: 277. Google Scholar
    • 2 : Rising incidence of renal cell cancer in the United States. JAMA1999; 281: 1628. Crossref, MedlineGoogle Scholar
    • 3 : Rising incidence of small renal masses: a need to reassess treatment effect. J Natl Cancer Inst2006; 98: 1331. Google Scholar
    • 4 : Renal cell cancer stage migration: analysis of the National Cancer Data Base. Cancer2008; 113: 78. Google Scholar
    • 5 : Guideline for management of the clinical T1 renal mass. J Urol2009; 182: 1271. LinkGoogle Scholar
    • 6 : EAU guidelines on renal cell carcinoma: the 2010 update. Eur Urol2010; 58: 398. Google Scholar
    • 7 : NCCN clinical practice guidelines in oncology: kidney cancer. J Natl Cancer Netw2009; 7: 618. Google Scholar
    • 8 : Partial nephrectomy versus radical nephrectomy in patients with small renal tumors—is there a difference in mortality and cardiovascular outcomes?. J Urol2009; 181: 55. LinkGoogle Scholar
    • 9 : Chronic kidney disease after nephrectomy in patients with renal cortical tumors: a retrospective cohort study. Lancet Oncol2006; 7: 735. Google Scholar
    • 10 : Renal and cardiovascular morbidity after partial or radical nephrectomy. Cancer2008; 112: 511. Google Scholar
    • 11 : Radical nephrectomy for pT1a renal masses may be associated with decreased overall survival compared with partial nephrectomy. J Urol2008; 179: 468. LinkGoogle Scholar
    • 12 : Partial versus radical nephrectomy for 4 to 7 cm renal cortical tumors. J Urol2009; 182: 2601. LinkGoogle Scholar
    • 13 : A prospective, randomized EORTC intergroup phase 3 study comparing the oncologic outcome of elective nephron-sparing surgery and radical nephrectomy for low-stage renal cell carcinoma. Eur Urol2011; 59: 543. Google Scholar
    • 14 : Trends in renal tumor surgery delivery within the United States. Cancer2010; 116: 2316. Google Scholar
    • 15 : Contemporary trends in nephrectomy for renal cell carcinoma in the United States: results from a population based cohort. J Urol2011; 186: 1779. LinkGoogle Scholar
    • 16 : Chronic kidney disease and mortality risk: a systematic review. J Am Soc Nephrol2006; 17: 2034. Google Scholar
    • 17 : Measuring inconsistency in meta-analyses. BMJ2003; 327: 557. Google Scholar
    • 18 : Outcome of stage T2 or greater renal cell cancer treated with partial nephrectomy. J Urol2010; 183: 903. LinkGoogle Scholar
    • 19 : Management of small unilateral renal cell carcinomas: radical versus nephron-sparing surgery. Urology1995; 45: 34. Crossref, MedlineGoogle Scholar
    • 20 : Renal cell carcinoma in octogenarians: Nephron sparing surgery should remain the standard of care. J Urol2011; 185: 415. LinkGoogle Scholar
    • 21 : Comparison of partial and radical nephrectomy for pT1b renal cell carcinoma. Korean J Urol2010; 51: 596. Google Scholar
    • 22 : Matched comparison of radical nephrectomy vs nephron-sparing surgery in patients with unilateral renal cell carcinoma and a normal contralateral kidney. Mayo Clin Proc2000; 75: 1236. Crossref, MedlineGoogle Scholar
    • 23 : Surgical management of renal tumors 4 cm. or less in a contemporary cohort. J Urol2000; 163: 730. LinkGoogle Scholar
    • 24 : Disease outcome in patients with low stage renal cell carcinoma treated with nephron sparing or radical surgery. J Urol1996; 155: 1868. LinkGoogle Scholar
    • 25 : Nephrectomy induced chronic renal insufficiency is associated with increased risk of cardiovascular death and death from any cause in patients with localized cT1b renal masses. J Urol2010; 183: 1317. LinkGoogle Scholar
    • 26 : Laparoscopic radical versus partial nephrectomy for tumors >4 cm: intermediate-term oncologic and functional outcomes. Urology2009; 73: 1077. Google Scholar
    • 27 : Comparison of complications after radical and partial nephrectomy: results from the National Veterans Administration Surgical Quality Improvement Program. BJU Int2000; 86: 782. Google Scholar
    • 28 : Impact of body mass index on survival of patients with surgically treated renal cell carcinoma. J Urol2006; 175: 46. LinkGoogle Scholar
    • 29 : Nephron-sparing surgery compared with radical nephrectomy for renal tumors: current indications and results. South Med J1997; 90: 982. Google Scholar
    • 30 : Survival rates after resection for localized kidney cancer: 1989 to 2004. Cancer2008; 113: 84. Google Scholar
    Advertisement