EURURO Vol. 71 No. 4

606 692

Review – Kidney Cancer
Partial Nephrectomy Versus Radical Nephrectomy for Clinical
T1b and T2 Renal Tumors: A Systematic Review and
Meta-analysis of Comparative Studies
Maria Carmen Mir Ithaar Derweesh Francesco Porpiglia Homayoun Zargar
Alexandre Mottrie Riccardo Autorino
a Department of Urology, Hospital del Mar-Parc de Salut Mar-IMIM, Barcelona, Spain; bDepartment of Urology, UC San Diego Health System, La Jolla, CA,
USA; c Division of Urology, Department of Oncology, University of Turin San Luigi Hospital, Orbassano, Italy; dUrology Department, Royal Melbourne
Hospital, University of Melbourne, Melbourne, Australia; e OLV Vattikuti Robotic Surgery Institute, Aalst, Belgium; f Urology Institute, University Hospitals,
Case Western Reserve University, Cleveland, OH, USA
available at
journal homepage:
Article info
Article history:
Accepted August 25, 2016
Associate Editor:
Giacomo Novara
Keywords:
Kidney cancer
Partial nephrectomy
Renal neoplasm
Renal mass
Radical nephrectomy
Renal function
Abstract
Background: Partial nephrectomy (PN) is the reference standard of management for a
cT1a renal mass. However, its role in the management of larger tumors (cT1b and cT2) is
still under scrutiny.
Objective: To conduct a meta-analysis assessing functional, oncologic, and perioperative
outcomes of PN and radical nephrectomy (RN) in the specific case of larger renal tumors
( cT1b). The primary endpoint was an overall analysis of cT1b and cT2 masses. The
secondary endpoint was a sensitivity analysis for cT2 only.
Evidence acquisition: A systematic literature review was performed up to December
2015 using multiple search engines to identify eligible comparative studies. A formal
meta-analysis was performed for studies comparing PN to RN for both cT1b and cT2
tumors. In addition, a sensitivity analysis including the subgroup of studies comparing
PN to RN for cT2 only was conducted. Pooled estimates were calculated using a fixed-
effects model if no significant heterogeneity was identified; alternatively, a random-
effects model was used when significant heterogeneity was detected. For continuous
outcomes, the weighted mean difference (WMD) was used as summary measure. For
binary variables, the odds ratio (OR) or risk ratio (RR) was calculated with 95% confi-
dence interval (CI). Statistical analyses were performed using Review Manager 5
(Cochrane Collaboration, Oxford, UK).
Evidence synthesis: Overall, 21 case-control studies including 11 204 patients (RN 8620;
PN 2584) were deemed eligible and included in the analysis. Patients undergoing PN
were younger (WMD 2.3 yr; p < 0.001) and had smaller masses (WMD 0.65 cm;
p < 0.001). Lower estimated blood loss was found for RN (WMD 102.6 ml; p < 0.001).
There was a higher likelihood of postoperative complications for PN (RR 1.74, 95% CI
1.34–2.2; p < 0.001). Pathology revealed a higher rate of malignant histology for the RN
group (RR 0.97; p = 0.02). PN was associated with better postoperative renal function, as
shown by higher postoperative estimated glomerular filtration rate (eGFR; WMD
12.4 ml/min; p < 0.001), lower likelihood of postoperative onset of chronic kidney
disease (RR 0.36; p < 0.001), and lower decline in eGFR (WMD 8.6 ml/min;
p < 0.001). The PN group had a lower likelihood of tumor recurrence (OR 0.6;
p < 0.001), cancer-specific mortality (OR 0.58; p = 0.001), and all-cause mortality
(OR 0.67; p = 0.005). Four studies compared PN (n = 212) to RN (n = 1792) in the specific
case of T2 tumors (>7 cm). In this subset of patients, the estimated blood loss was higher
* Corresponding author. Urology Institute, Case Western Reserve University, 27100 Chardon Road,
Richmond Heights, OH 44143, USA.
E-mail address: (R. Autorino).
0302-2838/# 2016 European Association of Urology. Published by Elsevier B.V. All rights reserved.