Skip to main content
SpringerLink
Log in

Perioperative and Oncological Outcomes of Partial Versus Radical Nephrectomy for Complex Renal Tumors (RENAL Score ≥ 7): Systematic Review and Meta-Analysis

  • Urologic Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Objective

Which is superior, partial nephrectomy (PN) or radical nephrectomy (RN), for the treatment of complex renal tumours (RENAL or score ≥ 7)?

Methods

This systematic review and meta-analysis was conducted in accordance with the PRISMA statement. A systematic search of the literature published before November 2023 was conducted using Pubmed, Embase, Cochran, and Web of Science libraries. We included studies comparing perioperative and oncologic outcomes of partial nephrectomy and radical nephrectomy for complex renal tumors.

Results

A total of 2602 patients from six studies meeting the criteria were included. The PN group had a longer operative time, increased estimated blood loss, and major complications but a smaller reduction in renal function. There were no significant differences in complications, length of hospital stay, and blood transfusion. In terms of oncological outcomes, the PN group had longer OS, CSS, and no significant difference in RFS.

Conclusions

For complex renal tumours, PN requires more operative time and has a higher chance of complications in the short term. However, in long-term follow-up, PN has a small decrease in renal function with longer OS and CSS.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6
Fig. 7
Fig. 8
Fig. 9
Fig. 10
Fig. 11

Similar content being viewed by others

References

  1. Siegel RL, Miller KD, Fuchs HE, et al. Cancer statistics. CA Cancer J Clin. 2022;72(1):7–33. https://doi.org/10.3322/caac.21708.

    Article  PubMed  Google Scholar 

  2. Siegel RL, Miller KD, Fuchs HE, et al. Cancer statistics. CA Cancer J Clin. 2021;71(1):7–33. https://doi.org/10.3322/caac.21654.

    Article  PubMed  Google Scholar 

  3. Mir MC, Derweesh I, Porpiglia F, et al. Partial nephrectomy versus radical nephrectomy for clinical T1b and T2 renal tumors: A systematic review and meta-analysis of comparative studies. Eur Urol. 2017;71(4):606–17. https://doi.org/10.1016/j.eururo.2016.08.060.

    Article  PubMed  Google Scholar 

  4. Kocher NJ, Kunchala S, Reynolds C, et al. Adherent perinephric fat at minimally invasive partial nephrectomy is associated with adverse peri-operative outcomes and malignant renal histology. BJU Int. 2016;117(4):636–41. https://doi.org/10.1111/bju.13378.

    Article  PubMed  Google Scholar 

  5. Kutikov A, Uzzo RG. The RENAL nephrometry score: a comprehensive standardized system for quantitating renal tumor size, location and depth. J Urol. 2009;182(3):844–53. https://doi.org/10.1016/j.juro.2009.05.035.

    Article  PubMed  Google Scholar 

  6. Ficarra V, Novara G, Secco S, et al. Preoperative aspects and dimensions used for an anatomical (PADUA) classification of renal tumours in patients who are candidates for nephron-sparing surgery. Eur Urol. 2009;56(5):786–93. https://doi.org/10.1016/j.eururo.2009.07.040.

    Article  PubMed  Google Scholar 

  7. Khalifeh A, Autorino R, Eyraud R, et al. Three-year oncologic and renal functional outcomes after robot-assisted partial nephrectomy. Eur Urol. 2013;64(5):744–50. https://doi.org/10.1016/j.eururo.2013.03.052.

    Article  PubMed  Google Scholar 

  8. Capitanio U, Terrone C, Antonelli A, et al. Nephron-sparing techniques independently decrease the risk of cardiovascular events relative to radical nephrectomy in patients with a T1a–T1b renal mass and normal preoperative renal function. Eur Urol. 2015;67(4):683–9. https://doi.org/10.1016/j.eururo.2014.09.027.

    Article  PubMed  Google Scholar 

  9. Thompson RH, Boorjian SA, Lohse CM, et al. Radical nephrectomy for pT1a renal masses may be associated with decreased overall survival compared with partial nephrectomy. J Urol. 2008;179(2):468–71. https://doi.org/10.1016/j.juro.2007.09.077.

    Article  PubMed  Google Scholar 

  10. Ljungberg B, Albiges L, Abu-Ghanem Y, et al. European association of urology guidelines on renal cell carcinoma: The 2022 update. Eur Urol. 2022;82(4):399–410. https://doi.org/10.1016/j.eururo.2022.03.006.

    Article  PubMed  Google Scholar 

  11. Liberati A, Altman DG, Tetzlaff J, et al. The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: explanation and elaboration. J Clin Epidemiol. 2009;62(10):e1-34. https://doi.org/10.1016/j.jclinepi.2009.06.006.

    Article  PubMed  Google Scholar 

  12. Stang A. Critical evaluation of the Newcastle-Ottawa scale for the assessment of the quality of nonrandomized studies in meta-analyses. Eur J Epidemiol. 2010;25(9):603–5. https://doi.org/10.1007/s10654-010-9491-z.

    Article  PubMed  Google Scholar 

  13. Sterne JA, Hernán MA, Reeves BC, et al. ROBINS-I: a tool for assessing risk of bias in non-randomised studies of interventions. BMJ. 2016;355 4919. https://doi.org/10.1136/bmj.i4919

  14. DerSimonian R, Laird N. Meta-analysis in clinical trials. Control Clin Trials. 1986;7(3):177–88. https://doi.org/10.1016/0197-2456(86)90046-2.

    Article  CAS  PubMed  Google Scholar 

  15. Cerrato C, Patel D, Autorino R, et al. Partial or radical nephrectomy for complex renal mass: a comparative analysis of oncological outcomes and complications from the ROSULA (Robotic Surgery for Large Renal Mass) Collaborative Group. World J Urol. 2023;41(3):747–55. https://doi.org/10.1007/s00345-023-04279-1.

    Article  PubMed  Google Scholar 

  16. Cerrato C, Meagher MF, Autorino R, et al. Partial versus radical nephrectomy for complex renal mass: multicenter comparative analysis of functional outcomes (Rosula collaborative group). Minerva Urol Nephrol. 2023;75(4):425–33. https://doi.org/10.23736/s2724-6051.23.05123-6.

    Article  PubMed  Google Scholar 

  17. Zhang X, Su Z, Lv P, et al. Functional, oncological outcomes and safety of nephron-sparing surgery versus radical nephrectomy in patients with localised renal cell carcinoma with high anatomical complexity: A retrospective cohort study with propensity score matching method. BMJ Open. 2021;11(12):e051622. https://doi.org/10.1136/bmjopen-2021-051622.

    Article  PubMed  PubMed Central  Google Scholar 

  18. Long G, Liu M, Zhang Y, et al. Robot-assisted laparoscopic partial nephrectomy is a safe and effective option for clinical T2 renal cell carcinoma: A case-series from single-institution. Transl Cancer Res. 2020;9(11):7140–8. https://doi.org/10.21037/tcr-20-2324.

    Article  PubMed  PubMed Central  Google Scholar 

  19. Deng W, Zhou Z, Zhong J, et al. Retroperitoneal laparoscopic partial versus radical nephrectomy for large (≥4 cm) and anatomically complex renal tumors: A propensity score matching study. Eur J Surg Oncol. 2020;46(7):1360–5. https://doi.org/10.1016/j.ejso.2019.12.010.

    Article  PubMed  Google Scholar 

  20. Liu TY, Li J, Wen XH, et al. The efficacy of open nephron-sparing surgery in the treatment of complex renal cell carcinoma. Eur Rev Med Pharmacol Sci. 2016;20(19):3959–64.

    PubMed  Google Scholar 

  21. Wells GA, Wells G, Shea B, et al. The Newcastle-Ottawa Scale (NOS) for assessing the quality of nonrandomised studies in meta-analyses. 2014.

  22. Siegel RL, Miller KD, Jemal A. Cancer statistics, 2018. CA Cancer J Clin. 2018;68(1):7–30. https://doi.org/10.3322/caac.21442.

    Article  PubMed  Google Scholar 

  23. Bray F, Ferlay J, Soerjomataram I, et al. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2018;68(6):394–424. https://doi.org/10.3322/caac.21492.

    Article  PubMed  Google Scholar 

  24. Li KP, Chen SY, Wang CY, et al. Comparison between minimally invasive partial nephrectomy and open partial nephrectomy for complex renal tumors: A systematic review and meta-analysis. Int J Surg. 2023;109(6):1769–82. https://doi.org/10.1097/js9.0000000000000397.

    Article  PubMed  PubMed Central  Google Scholar 

  25. Wang L, Deng JY, Liang C, et al. Perioperative, functional, and oncological outcomes of robotic vs. laparoscopic partial nephrectomy for complex renal tumors (RENAL score ≥7): an evidence-based analysis. Front Oncol. 2023;13:1195910. https://doi.org/10.3389/fonc.2023.1195910.

    Article  PubMed  PubMed Central  Google Scholar 

  26. Weight CJ, Larson BT, Fergany AF, et al. Nephrectomy induced chronic renal insufficiency is associated with increased risk of cardiovascular death and death from any cause in patients with localized cT1b renal masses. J Urol. 2010;183(4):1317–23. https://doi.org/10.1016/j.juro.2009.12.030.

    Article  PubMed  Google Scholar 

Download references

Acknowledgment

The author thanks Professor Yunxiang Li for his continued support and encouragement.

Funding

This study was supported by Sichuan Science and Technology Program under Grant number 2020YFS0320.

Author information

Author notes

  1. Zhiqiang Zeng and Si Ge contributed equally to this work.

Authors and Affiliations

  1. Nanchong Central Hospital, Nanchong, Sichuan, China

    Zhiqiang Zeng MM, Si Ge MM, Yunxiang Li PhD, Lijian Gan MM, Chunyang Meng MM, Kangsen Li MM, Zuoping Wang MM & Lei Zheng MM

  2. Department of Urology, School of Clinical Medicine, Southwest Medical University, Luzhou, Sichuan, China

    Zhiqiang Zeng MM, Si Ge MM & Yunxiang Li PhD

  3. Department of Urology, Nanchong Central Hospital, The Second Clinical College, North Sichuan Medical College (University), Nanchong, Sichuan, China

    Yunxiang Li PhD, Lijian Gan MM, Chunyang Meng MM, Kangsen Li MM, Zuoping Wang MM & Lei Zheng MM

Authors
  1. Zhiqiang Zeng MM
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Si Ge MM
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Yunxiang Li PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Lijian Gan MM
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Chunyang Meng MM
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Kangsen Li MM
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Zuoping Wang MM
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Lei Zheng MM
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Yunxiang Li PhD.

Ethics declarations

Disclosure

None declared.

Provenance and peer review

Not commissioned, externally peer-reviewed

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Zeng, Z., Ge, S., Li, Y. et al. Perioperative and Oncological Outcomes of Partial Versus Radical Nephrectomy for Complex Renal Tumors (RENAL Score ≥ 7): Systematic Review and Meta-Analysis. Ann Surg Oncol (2024). https://doi.org/10.1245/s10434-024-15223-x

Download citation

  • Received:

  • Accepted:

  • Published:

  • DOI: https://doi.org/10.1245/s10434-024-15223-x

Keywords

Search

Navigation