EURURO Vol. 71 No. 4

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Patients undergoing PN were younger (WMD 2.3 yr,
95% CI –3.5 to –1.1; p < 0.001) and had smaller masses
(WMD –0.65 cm, 95% CI –0.81. to –0.49; p < 0.001), whereas
there was no difference for baseline renal function, as
determined by baseline eGFR (WMD –0.50 ml/min, 95% CI –
3.2 to 2.2; p = 0.72). Similarly, there was no difference in the
proportion of patients with baseline CKD (RR 1.5, 95% CI
0.94–2.4; p = 0.09). There was also no difference in length of
follow-up between PN and RN patients (p = 0.27).
There was no significant difference in operative time
(WMD –10.9 min, 95% CI –17.8 to 39.6; p = 0.46), but there
was lower estimated blood loss for RN (WMD –102.6 ml,
95% CI 45.7, 159.5; p < 0.001). The likelihood of postopera-
tive complications was higher for PN (OR 1.74, 95% CI 1.34–
2.2; p < 0.001; ). Length of hospital stay was similar for
the two procedures (WMD –0.1 d, 95% CI –1.07 to 0.88;
p = 0.84). On pathology there was a higher rate of malignant
histology for the RN group (RR 0.97, 95% CI 0.95–1.00;
p = 0.02).
PN was associated with better postoperative renal
function, as shown by higher postoperative eGFR (WMD
12.4 ml/min, 95% CI 9.8–14.9; p < 0.001), lower likelihood
of onset of postoperative CKD (RR 0.36, 95% CI 0.52–0.76;
p < 0.001), and lower decline in eGFR (WMD –8.6 ml/min,
95% CI –12.6 to –4.7; p < 0.001; .
The likelihood of tumor recurrence was lower for PN (OR
0.6, 95% CI 0.46–0.79; p < 0.001), as was the likelihood of
cancer-specific mortality (OR 0.58, 95% CI 0.41–0.81;
p = 0.001) and all-cause mortality (OR 0.67, 95% CI 0.51–
0.88; p = 0.005; .
3.2. PN versus RN for cT2 only tumors
Four studies compared PN (n = 212) to RN (n = 1792) in the
specific case of T2 (>7 cm) tumors )
. There was no difference in terms of age (WMD –2.6 yr,
95% CI –6.3 to 1.1; p = 0.17), but tumor size was smaller for
PN (WMD –1.8 cm, 95% CI –3.3 to –0.3; p = 0.02).
With regard to surgical outcomes, higher estimated
blood loss was found for PN (WMD 107.6 ml, 95% CI 84.4–
130.7; p < 0.001), as well as a higher likelihood of
complications (RR 2.0, 95% CI 1.5–2.7; p < 0.001; .
Length of hospital stay was longer for PN, but the difference
did not reach statistical significance (WMD 0.7 d, 95% CI –
0.1 to 1.5; p = 0.11).
The recurrence rate was lower for the PN group (RR 0.61,
95% CI 0.44–0.86; p = 0.004), as was cancer-specific
mortality (RR 0.65, 95% CI 0.44–0.97; p = 0.03), but there
was no significant difference in all-cause mortality (RR 0.76,
95% CI 0.56–1.03; p = 0.07; ).
3.3. Interpretation of the data
We report the first meta-analysis of studies comparing PN
to RN for larger (T1b and T2) renal masses, for which the role
of nephron-sparing surgery is still debated. The present
analysis of a large pooled sample (>10 000 cases) can
contribute to the ongoing debate, ultimately paving the way
for further research on this topic, and provides key
information for contemporary evidence-based patient
counseling. Overall, we found that PN in these cases is a
Table 1 – Studies included in the meta-analysis for assessment of outcomes for partial nephrectomy (PN) versus radical nephrectomy (RN)
for cT1b and higher renal tumors
Reference Study period Study design Study origin T stage PN/RN Surgical SQ LE
Cases (n) Mean FU (mo) technique
Patard 1984–2001 RTP, MI France, Netherlands,
Italy, USA
T1b–2 379/1075 50.7/66.6 Open 7 III
Dash 1998–2004 RTP, PS, MI USA T1b–2 45/151 21^ Open 7 III
Mitchell 1988–2004 RTP, SC USA T1b–2 33/66 34/48.5 Open 7 III
Simmons 2001–2005 RTP, SC USA T1b–2 35/75 50/55 Lap 7 III
Antonelli 1983–2007 RTP, SC Italy T1b–2 52/277 59.2/78.8 Open 7 III
Thompson 1989–2006 RTP, MI USA T1b–2 286/873 40.8/63.6 Open/Lap 7 III
Weight 1999–2006 RTP, SC USA T1b–2 524/480 50/46 Open/Lap 7 III
Deklaj 2002–2008 RTP, SC USA T1b–2 33/60 15/21 Lap 7 III
Kim 1995–2004 RTP, SC Korea T1b–2 18/52 78.2/66.5 Open 7 III
Weight 1999–2006 RTP, SC USA T1b–2 212/298 49/41 Open/Lap 7 III
Antonelli 1995–2007 RTP, MI Italy T1b–2 198/1426 47 Open/Lap 7 III
Roos 1988–2007 RTP, SC Germany T1b–2 188/641 83.1/97.5 Open 7 III
Iizuka 1979–2011 RTP, SC Japan T1b–2 67/195 31.3/52.7 Open 7 III
Brewer 2004–2010 RTP, SC USA T1b–2 45/180 NS Lap/robotic 7 III
Milonas 1998–2009 RTP, SC Lithuania T1b–2 34/317 74.7/76.8 Open 7 III
Pignot 1984–2001 RTP, MI France, Italy, USA T1b–2 123/185 39.5/46.9 NS 7 III
Jang 1999–2011 RTP, PM, MI Korea T1b–2 100/477 48.1/42.6 Open 7 III
Margulis 1990–2006 RTP, SC USA T2 only 34/567 62.1/43.4 NS 8 III
Jeldres 1984–2001 RTP, MI Canada, France T2 only 29/896 57.6/55.2 NS 8 III
Brea 1970–2008 RTP, PM, SC USA T2 only 69/207 38.4 NS 8 IIa
Kopp 2002–2012 RTP, MI USA T2 only 80/122 41.5 Open/Lap 8 III
FU = follow-up; SQ = study quality according to the Newcastle-Ottawa scale; LE = level of evidence according to the Oxford Centre for Evidence-based Medicine;
RTP = retrospective; MI = multi-institutional; SC = single center; PS = propensity score; PM = pair matched; NS = not specified; Lap = laparoscopic.
a Median.
b These groups reported two separate analyses for the same data set (see the text).
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