Tumor Enucleation vs. Partial Nephrectomy for T1 Renal Cell Carcinoma: A Systematic Review and Meta-Analysis

Abstract

Purpose: Tumor enucleation (TE) and partial nephrectomy (PN) have both become main treatment strategies for T1 renal cell carcinoma (RCC), despite the discrepancy between their safety margin. We performed a meta-analysis on all the relevant trials in order to compare the clinical efficacy and safety of TE with those of PN for RCC treatment. Methods: In this meta-analysis, randomized controlled trials or retrospective studies were included if they compared TE and PN therapy in patients with localized renal cancer. The main outcomes extracted were perioperative data and post-operative outcomes. Subgroups for analyses were undertaken according to tumor size and duration of follow up. Data were pooled using the generic variance method with a fixed or random effects model and expressed as mean differences or odds ratios with 95% CI. Results: A total of 13 studies containing 1,792 patients undergoing TE and 3,068 undergoing PN were identified. Our study showed that the patients received TE had significantly shorter operative time (MD = -28.46, 95% CI = -42.09, -14.83, P < 0.0001), less hospital day (MD = -0.68, 95% CI = -1.04, -0.31, P = 0.0003), less estimate blood loss (MD = -59.90, 95% CI = -93.23, -26.58, P = 0.0004) and smaller change in estimated glomerular filtration rate (fixed effect: MD = 4.66, 95% CI = 1.67, 7.66, P = 0.002), fewer complications (fixed effect: OR = 0.65, 95% CI = 0.50, 0.85, P = 0.001) compared with those received PN. However, there were no significant differences in terms of warm ischemic time, positive margin rates, recurrence rates and survival rates between the two groups. All the subgroup analyses presented consistent results with the overall analyses. Conclusions: Our findings suggested that TE is not only less-traumatizing and beneficial for recovery, but also better for renal function protection. Moreover, it did not show the evidence of an increase relapse rate or mortality rate when compared with PN.

Keywords: meta-analysis; nephron sparing surgery; partial nephrectomy; renal cell carcinoma; tumor enucleation.

Figure 1

Flow diagram of literature search and study selection.

Figure 2

Forest plots of perioperative comparative data: operative time (A), hospital day (B), intraoperative EBL (C), WI time (D), positive margins (E).

Figure 3

Forest plots of post-operative outcomes: post-operative complications (A), change in eGFR (B), recurrence rate (C), 5-year CSS (D), 5-year PFS (E).

Figure 4

Forest plots of subgroups regarding recurrence rates: follow-up time (A), tumor size (B).

Figure 5

Results of an influence analysis in which the meta-analysis is re-estimated omitting each study in turn. Sensitivity analysis of instability in Positive Margins.