Investig Clin Urol.
2022 Mar;63(2):126-139. 10.4111/icu.20210361.
Tumor enucleation for the treatment of T1 renal tumors: A systematic review and meta-analysis
- Affiliations
-
- 1Department of Urology, Yonsei University Wonju College of Medicine, Wonju, Korea.
- 2Department of Nephrology, Yonsei University Wonju College of Medicine, Wonju, Korea.
- 3Center of Evidence Based Medicine, Institute of Convergence Science, Yonsei University, Seoul, Korea.
- 4Department of Urology, Chonnam National University Medical School, Chonnam National University Hwasun Hospital, Hwasun, Korea.
- 5Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea.
- 6Department of Hematology-Oncology, Chonnam National University Medical School, Chonnam National University Hwasun Hospital, Hwasun, Korea.
- KMID: 2526910
- DOI: http://doi.org/10.4111/icu.20210361
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According to protocol, we searched multiple data sources for published and unpublished randomized controlled trials and nonrandomized studies (NRSs) in any language.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; I 2 =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.
