-
Investigative and Clinical Urology Sep 2020This study aimed to determine the effectiveness and safety of partial nephrectomy (PN) without ischemia compared with PN with warm ischemia for reducing the... (Comparative Study)
Comparative Study Meta-Analysis
PURPOSE
This study aimed to determine the effectiveness and safety of partial nephrectomy (PN) without ischemia compared with PN with warm ischemia for reducing the deterioration in renal function in patients with cT1 renal tumors.
MATERIALS AND METHODS
We conducted a systematic review that included patients over 18 years of age who underwent PN with or without warm ischemia for cT1 renal tumors. The primary outcome was impaired renal function. A search strategy was performed in MEDLINE, EMBASE, LILACS, CENTRAL, the article reference lists, and the unpublished literature to reach saturation of the information. We assessed the risk of bias with the methodological index for nonrandomized studies (MINORS) tool, and we performed a meta-analysis according to the type of variable.
RESULTS
We found a total of 5,682 articles, of which 14 met the inclusion criteria. Seven studies evaluated renal function, identifying a difference in means (MD) of 3.50 (95% confidence interval [CI], 1.16 to 5.83), favoring no ischemia. We did not find any significant differences regarding intraoperative bleeding or operative time (MD, 55 mL; 95% CI, -33.16 to 144.08; and MD, 1.87; 95% CI, -20.47 to 24.21; respectively).
CONCLUSIONS
In this study, PN without ischemia showed a decrease in deterioration of the estimated glomerular filtration rate compared with warm ischemia.
Topics: Humans; Kidney Neoplasms; Neoplasm Staging; Nephrectomy; Treatment Outcome; Warm Ischemia
PubMed: 32869563
DOI: 10.4111/icu.20190313 -
Frontiers in Oncology 2019Tumor enucleation (TE) and partial nephrectomy (PN) have both become main treatment strategies for T1 renal cell carcinoma (RCC), despite the discrepancy between their...
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. 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. 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, < 0.0001), less hospital day (MD = -0.68, 95% CI = -1.04, -0.31, = 0.0003), less estimate blood loss (MD = -59.90, 95% CI = -93.23, -26.58, = 0.0004) and smaller change in estimated glomerular filtration rate (fixed effect: MD = 4.66, 95% CI = 1.67, 7.66, = 0.002), fewer complications (fixed effect: OR = 0.65, 95% CI = 0.50, 0.85, = 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. 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.
PubMed: 31214511
DOI: 10.3389/fonc.2019.00473 -
Frontiers in Surgery 2022Partial nephrectomy (PN) is one of the most preferred nephron-sparing treatments for clinical T1 (cT1) renal cancer, while radiofrequency ablation (RFA) is usually used...
BACKGROUND
Partial nephrectomy (PN) is one of the most preferred nephron-sparing treatments for clinical T1 (cT1) renal cancer, while radiofrequency ablation (RFA) is usually used for patients who are poor surgical candidates. The long-term oncologic outcome of RFA vs. PN for cT1 renal cancer remains undetermined. This meta-analysis aims to compare the treatment efficacy and safety of RFA and PN for patients with cT1 renal cancer with long-term follow-up of at least 5 years.
METHOD
This meta-analysis was performed following the PRISMA reporting guidelines. Literature studies that had data on the comparison of the efficacy or safety of RFA vs. PN in treating cT1 renal cancer were searched in databases including PubMed, Embase, Web of Science, and the Cochrane Library from 1 January2000 to 1 May 2022. Only long-term studies with a median or mean follow-up of at least 5 years were included. The following measures of effect were pooled: odds ratio (OR) for recurrence and major complications; hazard ratio (HR) for progression-free survival (PFS), cancer-specific survival (CSS), and overall survival (OS). Additional analyses, including sensitivity analysis, subgroup analysis, and publication bias analysis, were also performed.
RESULTS
A total of seven studies with 1,635 patients were finally included. The treatment efficacy of RFA was not different with PN in terms of cancer recurrence (OR = 1.22, 95% CI, 0.45-3.28), PFS (HR = 1.26, 95% CI, 0.75-2.11), and CSS (HR = 1.27, 95% CI, 0.41-3.95) as well as major complications (OR = 1.31, 95% CI, 0.55-3.14) ( > 0.05 for all). RFA was a potential significant risk factor for OS (HR = 1.76, 95% CI, 1.32-2.34, < 0.001). No significant heterogeneity and publication bias were observed.
CONCLUSION
This is the first meta-analysis that focuses on the long-term oncological outcomes of cT1 renal cancer, and the results suggest that RFA has comparable therapeutic efficacy with PN. RFA is a nephron-sparing technique with favorable oncologic efficacy and safety and a good treatment alternative for cT1 renal cancer.
PubMed: 36684152
DOI: 10.3389/fsurg.2022.1012897 -
Urology Journal Mar 2020Radical nephrectomy (RN) and partial nephrectomy (PN) are widely used for early-stage renal cell carcinoma (RCC). However, the results were inconsistent while comparing... (Meta-Analysis)
Meta-Analysis
PURPOSE
Radical nephrectomy (RN) and partial nephrectomy (PN) are widely used for early-stage renal cell carcinoma (RCC). However, the results were inconsistent while comparing the efficiency of RN and PN. This study aimed to assess the perioperative effectiveness of RN and PN for treating RCC.
MATERIAL AND METHODS
PubMed, Embase, and the Cochrane Library electronic database were searched for studies on adults with RCC comparing RN and PN published until September 2019. The perioperative efficacy and safety outcomes were calculated using odds ratio (OR) and standard mean difference (SMD) with 95% confidence intervals (CIs) for dichotomous and continuous data, respectively. Subgroup analysis were conducted based on tumor stage and surgery methods for evaluation of the treatment effect on specific subsets.
RESULTS
A total of 23 studies involving 30,018 patients with RCC were included in this meta-analysis. Notably, RCC treated with PN was associated with low incidences of hospital mortality (OR: 0.58; 95% CI: 0.38-0.89; P = 0.013) and reoperation rate (OR: 0.74; 95% CI: 0.58-0.95; P = 0.016) as compared to RN. However, PN was associated with an increased risk of overall postoperative complications (OR: 1.40; 95% CI: 1.17-1.68, P < 0.001), postoperative hemorrhagic complications (OR: 1.92; 95% CI: 1.28-2.87, P = 0.002), and urinary fistula (OR: 17.65; 95% CI: 5.35-58.30, P < 0.001) as compared to RN.
CONCLUSION
These findings suggested that PN was associated with lower incidences of hospital mortality and reoperation rate, whereas RN was associated with fewer complications.
Topics: Carcinoma, Renal Cell; Humans; Neoplasm Staging; Nephrectomy; Postoperative Complications; Reoperation; Treatment Outcome
PubMed: 32180211
DOI: 10.22037/uj.v0i0.5358 -
Cancers Feb 2024: Robot-assisted partial nephrectomy (RAPN) is increasingly being employed in the management of renal cell carcinoma (RCC) and it is expanding in the field of complex... (Review)
Review
: Robot-assisted partial nephrectomy (RAPN) is increasingly being employed in the management of renal cell carcinoma (RCC) and it is expanding in the field of complex renal tumors. The aim of this systematic review was to consolidate and assess the results of RAPN when dealing with entirely central hilar masses and to examine the various methods used to address the surgical difficulties associated with them. : A thorough literature search in September 2023 across various databases focused on RAPN for renal hilar masses, adhering to PRISMA guidelines. The primary goal was to evaluate RAPN's surgical and functional outcomes, with a secondary aim of examining different surgical techniques. Out of 1250 records, 13 full-text manuscripts were reviewed. : Evidence is growing in favor of RAPN for renal hilar masses. Despite a predominance of retrospective studies and a lack of long-term data, RAPN shows positive surgical outcomes and preserves renal function without compromising cancer treatment effectiveness. Innovative suturing and clamping methods are emerging in surgical management. : RAPN is a promising technique for managing renal hilar masses in RCC, offering effective surgical outcomes and renal function preservation. The study highlights the need for more long-term data and prospective studies to further validate these findings.
PubMed: 38398084
DOI: 10.3390/cancers16040693 -
In Vivo (Athens, Greece) 2022Trifecta represents a composite outcome reflecting the quality level of treatment in nephron sparing surgery. However, there is substantial heterogeneity concerning the... (Review)
Review
BACKGROUND/AIM
Trifecta represents a composite outcome reflecting the quality level of treatment in nephron sparing surgery. However, there is substantial heterogeneity concerning the criteria required for its fulfilment. The present study aimed to highlight the potential of a unified view for the different definitions of trifecta when comparing robotic and open approaches in partial nephrectomy.
MATERIALS AND METHODS
A systematic literature search was carried out for all relevant comparative studies published until April 2022. Trifecta definitions were clustered according to two criteria for postoperative renal function reduction. The first set as an upper limit the 10% decrease in the estimated glomerular filtration rate, while the second set as an upper limit 25 min of ischemia. To mathematically investigate the point of intersection between the above two groups, a suitable model of volume conservation equations was formulated.
RESULTS
A total of 11 studies were investigated for their methodological features and grouped accordingly. The ischemic zone volume surrounding the tumor resection site emerged as the central parameter connecting the two main definitions. Specifically, for patients with solitary renal masses, a given change in the value of one parameter resulted in a fixed change in the value of the other.
CONCLUSION
The two main definitions of the "trifecta outcome" extracted from the international literature represent the two sides of the same coin. Thus, trifecta achievement rates could be utilized by future studies as aggregate data to yield a quantitative estimate of the comparative effect between robotic and open approaches in partial nephrectomy procedures.
Topics: Humans; Models, Theoretical; Nephrectomy; Robotic Surgical Procedures; Treatment Outcome
PubMed: 36309375
DOI: 10.21873/invivo.12992 -
International Journal of Surgery... Dec 2020To investigate the overall prevalence of benign pathology after partial nephrectomy (PN) and identify predictive factors for benign pathology after PN. (Meta-Analysis)
Meta-Analysis
OBJECTIVE
To investigate the overall prevalence of benign pathology after partial nephrectomy (PN) and identify predictive factors for benign pathology after PN.
METHODS
A systematic review was performed following the PRISMA guidelines. PubMed/Medline, Embase, and the Cochrane Library were searched up to January 2019PRISMA guidelines. The data for the meta-analysis and network meta-analysis were pooled using a random-effects model.
RESULTS
There were 144 studies included in the final analysis, which was comprised of 79 observational studies (n = 37,300) and 65 comparative studies (n = 18,552). The overall prevalence rate of benign pathology after PN was 0.19 (95% CI: 0.18-0.21). According to the procedure types, the prevalence rate of benign pathology was 0.17 (95% CI: 0.15-0.19), 0.24 (95% CI: 0.22-0.27), and 0.16 (95% CI: 0.15-0.18) in open partial nephrectomy, laparoscopic partial nephrectomy, and robot-assisted laparoscopic partial nephrectomy, respectively. The significant moderating factors were gender, publication year, the origin of the study, and procedure types. The three most common benign pathology types were oncocytomas, angiomyolipomas, and renal cysts (44.50%, 30.20%, and 10.99%, respectively).
CONCLUSIONS
The overall prevalence of benign pathology after PN was not low and it was affected by female gender, studies published before 2010, studies originating from Western areas, and laparoscopic procedure types.
Topics: Angiomyolipoma; Humans; Kidney Neoplasms; Laparoscopy; Nephrectomy; Prevalence; Robotic Surgical Procedures
PubMed: 33220454
DOI: 10.1016/j.ijsu.2020.11.009 -
Turkish Journal of Urology May 2022Clamping of renal vessels during partial nephrectomy is usually performed to improve the visualization of tumor margins. However, clamping of renal vessels has been...
Clamping of renal vessels during partial nephrectomy is usually performed to improve the visualization of tumor margins. However, clamping of renal vessels has been associated with detrimental effects on renal function after surgery. This study aimed to compare artery only versus artery and vein clamping as regards the surgical and functional outcomes in patients undergoing partial nephrectomy. The literature was searched for English published studies from January 1, 2000 to August 7, 2021. The search included MEDLINE/ PubMed, Cochrane Library, Scopus, Web of Science, Google Scholar, and ProQuest, using the terms {"par- tial nephrectomy"} OR {"nephron-sparing surgery"} AND {"renal artery and vein clamping} AND {"renal artery only clamping}. Nine studies were included. Meta-analysis showed the artery only clamping grouphad a significantly less percentage of change in glomerular filtration rate at last follow-up (standardizedmean difference: -0.42 [95% CI: -0.70, -0.13], P = .004) as well as a rate of postoperative complications(odds ratio: 0.64 [95% CI: 0.41, 0.98], P = .04). However, no significant difference was observed regarding the development of chronic kidney disease. There was no significant difference regarding the warm ischemiatime, blood loss, or positive surgical margin. Artery only clamping has a comparable safety to artery and vein clamping and may produce a renoprotective effect. Due to limitations of the included studies, the conduction of large-size randomized clinical trials with a long duration of follow-up is required before recommending the replacement of artery and vein clamping with artery only clamping during partial nephrectomy.
PubMed: 35634936
DOI: 10.5152/tud.2022.22009 -
Cancer Medicine Aug 2021To parallelly compare the applicability of the radius, exophytic/endophytic, nearness, anterior/posterior, location nephrometry score (R.E.N.A.L.), the Preoperative... (Comparative Study)
Comparative Study Meta-Analysis
OBJECTIVE
To parallelly compare the applicability of the radius, exophytic/endophytic, nearness, anterior/posterior, location nephrometry score (R.E.N.A.L.), the Preoperative Aspects and Dimensions Used for an Anatomical (PADUA), and the centrality index (C-index) scoring systems in predicting clinical outcomes after partial nephrectomy (PN).
METHODS
We searched EMBASE, PubMed, Ovid, and Web of Science to perform a meta-analysis examining the correlation coefficients between three nephrometry scores (NSs) and warm ischemia time (WIT), estimated blood loss (EBL), operation time (OT), length of stay (LOS), and absolute change in eGFR (ACE) up to 25 January 2021.
RESULTS
In total, 13 studies including 1496 patients met the criteria for further analysis. Overall, all scoring systems had statistically significant correlations with the WIT, EBL, OT, ACE and LOS and ACE, except for the correlation between PADUA and LOS (r = 0.16 [-0.00, 0.31], p > 0.05). The C-index had the strongest correlation with WIT (r = -0.35 [-0.43, -0.26], p < 0.05) and ACE (r = -0.29 [-0.48, -0.10], p < 0.05). Weak correlations were observed between OT as well as EBL and each scoring system. Publication bias was observed in PADUA score predicting ACE (p = 0.04) and high heterogeneity was found in some of our results.
CONCLUSION
Until now, this is the first meta-analysis that parallelly compares these three scoring systems in predicting outcomes after PN. We found that all NSs showed a statistically significant correlation with WIT, EBL, OT, and ACE. Moreover, the C-index scoring system is the best predictor of WIT and ACE. Due to the existence of publication bias and high heterogeneity, more well-designed and large-scale studies are warranted for validation.
Topics: Blood Loss, Surgical; Carcinoma, Renal Cell; Glomerular Filtration Rate; Humans; Kidney; Kidney Neoplasms; Length of Stay; Nephrectomy; Operative Time; Publication Bias; Research Design; Retrospective Studies; Treatment Outcome; Warm Ischemia
PubMed: 34258874
DOI: 10.1002/cam4.4047 -
Minerva Urologica E Nefrologica = the... Apr 2019Robot-assisted partial nephrectomy (RAPN) is increasingly used for the surgical management of renal masses. Aim of this study was to analyze the available literature... (Comparative Study)
Comparative Study
INTRODUCTION
Robot-assisted partial nephrectomy (RAPN) is increasingly used for the surgical management of renal masses. Aim of this study was to analyze the available literature regarding the outcomes of RAPN compared to those of open partial nephrectomy (OPN).
EVIDENCE ACQUISITION
A literature search was performed up to October 2018 using PubMed, MEDLINE and Embase. Article selection followed the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) principles and Population, Intervention, Comparator, Outcomes (PICO) methodology was used. Population (P) was patients with renal masses who underwent RAPN (I). RAPN was compared with OPN (C). Outcomes of interest were perioperative, oncological and functional outcomes of both surgical procedures (O). Inclusion criteria were: randomized controlled studies andobservational cohort studies comparing RAPN versus OPN, which reported at least one outcome of interest.
EVIDENCE SYNTHESIS
Twenty-two manuscripts met our inclusion criteria and were included in the systematic review. RAPN was superior to OPN in terms of complication rate in 11 studies while similar results were observed in 9 studies. Positive surgical margins were similar in 13 studies while RAPN had lower surgical margins in 6 studies. Operative and warm ischemia times were longer in OPN in 13 and 10 studies, respectively. Seventeen and 19 studies showed that estimated blood loss and length of hospital stay were higher in RAPN. Estimated glomerular filtration rate decline and chronic kidney disease upstaging decline were similar in the majority of studies.
CONCLUSIONS
Current evidence demonstrate that RAPN is a reasonable alternative to OPN with regard to oncological and early functional outcomes with a straightforward advantage of improved perioperative morbidity, as expected by minimally invasive techniques. Nevertheless, there is still a great need for well-designed randomized studies with an extended follow-up.
Topics: Humans; Kidney Neoplasms; Nephrectomy; Robotic Surgical Procedures; Treatment Outcome
PubMed: 30895768
DOI: 10.23736/S0393-2249.19.03391-5