For patients with T1b renal cell carcinoma (RCC), partial nephrectomy provides long-term overall survival similar to that of radical nephrectomy, but with worse cancer-specific survival (CSS).

This the first meta-analysis of long-term oncologic outcomes between the surgical approaches, Yu-Li Jiang, MD, of The Affiliated Hospital of Hang Zhou Normal University in China, and colleagues reported in BMC Urology.

In their meta-analysis of 16 studies including 33,117 RCC patients with 4 to 7 cm tumors, no significant differences were found in 5- and 10-year overall survival (OS) or 5- and 10-year recurrence-free survival (RFS). However, radical nephrectomy (RN) slightly outperformed partial nephrectomy (PN) in CSS at 5 and 10 years. Results from previous studies have been conflicting, with some showing better CSS with PN.

Consistent with previous reports, PN preserved renal function better than RN. In 4 of the included studies, estimated glomerular filtration rate (eGFR) declined more (weighted mean difference −9.15) in the RN group.

PN and RN patients had comparable complication rates, the team found. Yet, they noted that tumor histology could affect outcomes.

“Our meta-analysis showed that PN may provide comparable outcomes in terms of RFS and OS, and better renal function preservation,” Dr Jiang and the team concluded. The evidence received a GRADE of moderate.

In an acknowledgement of study limitations, the authors noted that they did not include randomized controlled trials in the meta-analysis. The meta-analysis also was limited by potential selection bias because surgeons decided between PN and RN based on personal preference.

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Reference

Jiang YL, Peng CX, Wang HZ, Qian LJ. Comparison of the long-term follow-up and perioperative outcomes of partial nephrectomy and radical nephrectomy for 4 cm to 7 cm renal cell carcinoma: a systematic review and meta-analysis. BMC Urol. 19:48. doi:10.1186/s12894-019-0480-6