A meta-analysis recently appearing in the International Brazilian Journal of Urology offers evidence that partial nephrectomy may be just as effective as radical nephrectomy in patients with pathological stage T3a (pT3a) renal cell carcinoma (RCC). Furthermore, partial nephrectomy preserves more kidney function than radical nephrectomy, the current standard of surgical treatment for the disease.
The authors, led by Huan Deng, of the Department of Thoracic Surgery at the Second Affiliated Hospital of Nanchang University in China, searched PubMed, Scopus, Web of Science, Science Direct, Ovid MEDLINE, The Cochrane Library, Embase and Google Scholar. They identified 12 studies involving more than 14,000 patients. They then assessed oncologic outcomes, perioperative outcomes, and renal function between two groups of patients with pT3a RCC: those who received partial nephrectomy and those who received radical nephrectomy.
Outcomes of interest and results were as follows:
- Survival: The analysis found no differences between groups in overall survival, cancer-specific survival, or recurrence-free survival.
- Surgical complications: The analysis found no significant differences between groups in surgical complications, including prolonged bleeding, wound problems, urine leakage, and prolonged ileus.
- Operative time: Operative time was similar between groups.
- Estimated blood loss: Both groups had similar rates of blood loss.
- Renal function: Patients who received partial nephrectomy had lower serum creatinine and higher glomerular filtration rate, indicating better renal preservation.
- Positive margins: Those who received partial nephrectomy had a higher incidence of positive margins than those who received radical nephrectomy.
“Partial nephrectomy may be more suitable for treating pT3a RCC than radical nephrectomy because it provides a similar survival time and superior renal function,” the authors wrote. “The most attractive and beneficial feature of partial nephrectomy compared with radical nephrectomy is better renal function, which might decrease the risk of cardiovascular and metabolic events that may ultimately translate into better overall survival.”
However, the authors acknowledged the need for high-quality studies to confirm the controversial findings.