Comparison Of Nephron-sparing Surgery And Radical Nephrectomy For Localized Renal Tumors:A Systematic Review And Meta-analysis

Objective The purpose of this study was to retrieve relative literature those compare prognostic outcomes, renal functions and postoperative complications of nephron-sparing surgery (NSS) or partial nephrectomy (PN) versus radical nephrectomy (RN) in treating 4-7cm renal tumors.Methods First we searched English databases included English Elsevier Science Direct, PubMed, Web of Science, Co-chrane Library, etc; then we searched Chinese databases included Chinese academic literature pool (CNKI), Chinese Biomedical Literature Database (CBM), Chinese science and technology periodical database (VIP) and Wan fang database. We used reasonable search strategies to retrieve all studies on NSS and RN treating 4-7cm renal tumors. Then we read the titles and the abstracts of the literatures to determine whether they were relevant, in which we download the full text of the document. And read the text further to determine whether it should be include in the study. We also browsed the references of the literatures. In accordance with the inclusion criteria and exclusion criteria, quality assessment and data extraction, we used Statal2.0 statistical analysis software for data consolidation. The HR and 95% confidence interval (confidence interval, CI) was used to compare the efficacy of NSS and RN treating renal tumors, and OR and 95% CI was used to compare the incidence of postoperative complications.Results The study found that compared NSS to RN the cancer specific mortality (HR=0.86; (0.71,1.03))and all cause mortality (HR=0.83; (0.59,1.17))between the two groups of patients had no significant statistical difference, and the incidence of postoperative complications (OR=1.58; (0.81,3-06)) had no difference either.Conclusions Our study shows that NSS and RN for renal tumors 4-7cm can get similar oncology outcomes in cancer specific mortality and all cause mortality. The incidence of complications have no difference, in a certain extent, NSS can preserve the renal function better, and reduce the incidence of postoperative chronic kidney diseases. Therefore, we believe that if the technology feasible, and taking fully consideration in the size of the tumors and the patients’situations, NSS is safe and effective.