Tumor enucleation for the treatment of T1 renal tumors: A systematic review and meta-analysis

Abstract

Purpose: To evaluate the clinical efficacy and safety of tumor enucleation (TE) compared with partial nephrectomy (PN) for T1 renal cell carcinoma.

Materials and methods: According to protocol, we searched multiple data sources for published and unpublished randomized controlled trials and nonrandomized studies (NRSs) in any language. We performed systematic review and meta-analysis according to the Cochrane Handbook for Systematic Reviews of Interventions and rated the certainty of the evidence (CoE) using the GRADE framework.

Results: We are uncertain about the effects of TE on perioperative (mean difference [MD] 3.38, 95% CI 1.52 to 5.23; I²=68%; 4 NRSs; 942 participants; very low CoE) and long-term (MD 2.31, 95% CI -1.40 to 6.01; I²=57%; 4 NRSs; 542 participants; very low CoE) residual renal function. TE may result in little to no difference in short-term residual renal function (MD 1.04, 95% CI 0.25 to 1.83; I²=0%; 2 NRSs; 256 participants; low CoE). We are uncertain about the effects of TE on cancer-specific mortality (risk ratio [RR] 0.90, 95% CI: 0.11 to 7.28; I²=0%; 2 NRSs; 551 participants; very low CoE) and major adverse events (RR 0.48, 95% CI: 0.30 to 0.79; I²=0%; 10 NRS; 2,360 participants; very low CoE).

Conclusions: While TE appears to have similar effects on short term postoperative residual renal function, there were uncertainties on mortality and major adverse events. However, we need rigorous RCTs to elucidate the effects of TE as the evidence stems mostly from NRSs.

Keywords: Nephrectomy; Renal cell carcinoma; Systematic review.

Fig. 1. PRISMA 2009 flow diagram.

Fig. 2. Risk of bias summary. Review authors’ judgements about each risk of bias item for each included study. Cr, creatinine; GFR, glomerular filtration rate. ^a:Only abstracts have been published.

Fig. 3. Risk of bias summary. ROBINS-I outcome set 1: glomerular filtration rate (perioperative), cancer-specific mortality, local recurrence, distant metastasis; set 2: glomerular filtration rate (short-term); set 3: glomerular filtration rate (long-term); set 4: major adverse events; set 5: positive surgical margin; set 6: overall adverse event, hospital stay. Figure created using robvis: https://www.riskofbias.info/welcome/robvis-visualization-tool.