Systematic review of oncological outcomes following surgical management of localised renal cancer

Steven MacLennan, Mari Imamura, Marie Carmela M. Lapitan, Muhammad Imran Omar, Thomas Boon Leong Lam, AM Hilvano-Cabungcal, P. Royle, Fiona Stewart, Graeme Stewart MacLennan, Sara MacLennan, SE Canfield, Sam McClinton, T R L Griffiths, B Ljungberg, James Michael Olu N'Dow

Research output: Contribution to journalArticle

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Abstract

Context
Renal cell carcinoma (RCC) accounts for 2–3% of adult malignancies. There remain uncertainties over the oncological outcomes for the surgical management of localised RCC.

Objective
Systematically review relevant literature comparing oncological outcomes of surgical management of localised RCC (T1–2N0M0).

Evidence acquisition
Relevant databases including Medline, Embase, and the Cochrane Library were searched up to October 2010, and an updated scoping search was performed up to January 2012. Randomised controlled trials (RCTs) or quasi-RCTs, prospective observational studies with controls, retrospective matched-pair studies, and comparative studies from well-defined registries/databases were included. The main outcomes were overall survival, cancer-specific survival, recurrence, and metastases. The Cochrane risk of bias tool was used to assess RCTs, and an extended version was used to assess nonrandomised studies (NRSs). The quality of evidence was assessed using Grading of Recommendations Assessment, Development, and Evaluation (GRADE).

Evidence synthesis
A total of 4580 abstracts and 389 full-text articles were assessed. Thirty-four studies met the inclusion criteria (6 RCTs and 28 NRSs). Meta-analyses were planned but were deemed inappropriate due to data heterogeneity. There were high risks of bias and low-quality evidence across the evidence base. Open radical nephrectomy and open partial nephrectomy showed similar cancer-specific and overall survival, but when both open and laparoscopic approaches are considered together, the evidence showed improved survival for partial nephrectomy for tumours =4 cm. The overall evidence suggests either equivalent or better survival with partial nephrectomy. Laparoscopic radical nephrectomy offered equivalent survival to open radical nephrectomy, and all laparoscopic approaches achieved equivalent survival. Open and laparoscopic partial nephrectomy achieved equivalent survival. The issue of ipsilateral adrenalectomy or complete lymph node dissection with radical nephrectomy or partial nephrectomy remains unresolved.

Conclusions
The evidence base suggests localised RCCs are best managed by nephron-sparing surgery where technically feasible. However, the current evidence base has significant limitations due to studies of low methodological quality marked by high risks of bias.

Original languageEnglish
Pages (from-to)972-993
Number of pages22
JournalEuropean Urology
Volume61
Issue number5
Early online date24 Feb 2012
DOIs
Publication statusPublished - May 2012

Fingerprint

Kidney Neoplasms
Nephrectomy
Randomized Controlled Trials
Neoplasms
Databases
Adrenalectomy
Nephrons
Lymph Node Excision
Libraries
Uncertainty
Observational Studies
Registries
Meta-Analysis
Prospective Studies
Neoplasm Metastasis
Carcinoma
Recurrence

Keywords

  • localised renal cance
  • oncological outcomes
  • radical nephrectomy
  • adenalectomy
  • lymphadenectomy
  • partial nephrectomy
  • nephron-sparing surgery
  • cryoablation
  • radiofrequency ablation
  • HIFU
  • systematic reviews
  • meta-analysis

Cite this

Systematic review of oncological outcomes following surgical management of localised renal cancer. / MacLennan, Steven; Imamura, Mari; Lapitan, Marie Carmela M.; Omar, Muhammad Imran; Lam, Thomas Boon Leong; Hilvano-Cabungcal, AM; Royle, P.; Stewart, Fiona; MacLennan, Graeme Stewart; MacLennan, Sara; Canfield, SE; McClinton, Sam; Griffiths, T R L ; Ljungberg, B; N'Dow, James Michael Olu.

In: European Urology, Vol. 61, No. 5, 05.2012, p. 972-993.

Research output: Contribution to journalArticle

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abstract = "Context Renal cell carcinoma (RCC) accounts for 2–3{\%} of adult malignancies. There remain uncertainties over the oncological outcomes for the surgical management of localised RCC. Objective Systematically review relevant literature comparing oncological outcomes of surgical management of localised RCC (T1–2N0M0). Evidence acquisition Relevant databases including Medline, Embase, and the Cochrane Library were searched up to October 2010, and an updated scoping search was performed up to January 2012. Randomised controlled trials (RCTs) or quasi-RCTs, prospective observational studies with controls, retrospective matched-pair studies, and comparative studies from well-defined registries/databases were included. The main outcomes were overall survival, cancer-specific survival, recurrence, and metastases. The Cochrane risk of bias tool was used to assess RCTs, and an extended version was used to assess nonrandomised studies (NRSs). The quality of evidence was assessed using Grading of Recommendations Assessment, Development, and Evaluation (GRADE). Evidence synthesis A total of 4580 abstracts and 389 full-text articles were assessed. Thirty-four studies met the inclusion criteria (6 RCTs and 28 NRSs). Meta-analyses were planned but were deemed inappropriate due to data heterogeneity. There were high risks of bias and low-quality evidence across the evidence base. Open radical nephrectomy and open partial nephrectomy showed similar cancer-specific and overall survival, but when both open and laparoscopic approaches are considered together, the evidence showed improved survival for partial nephrectomy for tumours =4 cm. The overall evidence suggests either equivalent or better survival with partial nephrectomy. Laparoscopic radical nephrectomy offered equivalent survival to open radical nephrectomy, and all laparoscopic approaches achieved equivalent survival. Open and laparoscopic partial nephrectomy achieved equivalent survival. The issue of ipsilateral adrenalectomy or complete lymph node dissection with radical nephrectomy or partial nephrectomy remains unresolved. Conclusions The evidence base suggests localised RCCs are best managed by nephron-sparing surgery where technically feasible. However, the current evidence base has significant limitations due to studies of low methodological quality marked by high risks of bias.",
keywords = "localised renal cance, oncological outcomes, radical nephrectomy, adenalectomy, lymphadenectomy, partial nephrectomy, nephron-sparing surgery, cryoablation, radiofrequency ablation, HIFU, systematic reviews, meta-analysis",
author = "Steven MacLennan and Mari Imamura and Lapitan, {Marie Carmela M.} and Omar, {Muhammad Imran} and Lam, {Thomas Boon Leong} and AM Hilvano-Cabungcal and P. Royle and Fiona Stewart and MacLennan, {Graeme Stewart} and Sara MacLennan and SE Canfield and Sam McClinton and Griffiths, {T R L} and B Ljungberg and N'Dow, {James Michael Olu}",
note = "UCAN Cancer Charity (www.ucanhelp.org.uk) and MacMillan Cancer Charity helped design and conduct the study Corrigendum to “Systematic Review of Oncological Outcomes Following Surgical Management of Localised Renal Cancer” [Eur Urol 2012;61:972–93] European Urology, Volume 62, Issue 1, July 2012, Page 193",
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T1 - Systematic review of oncological outcomes following surgical management of localised renal cancer

AU - MacLennan, Steven

AU - Imamura, Mari

AU - Lapitan, Marie Carmela M.

AU - Omar, Muhammad Imran

AU - Lam, Thomas Boon Leong

AU - Hilvano-Cabungcal, AM

AU - Royle, P.

AU - Stewart, Fiona

AU - MacLennan, Graeme Stewart

AU - MacLennan, Sara

AU - Canfield, SE

AU - McClinton, Sam

AU - Griffiths, T R L

AU - Ljungberg, B

AU - N'Dow, James Michael Olu

N1 - UCAN Cancer Charity (www.ucanhelp.org.uk) and MacMillan Cancer Charity helped design and conduct the study Corrigendum to “Systematic Review of Oncological Outcomes Following Surgical Management of Localised Renal Cancer” [Eur Urol 2012;61:972–93] European Urology, Volume 62, Issue 1, July 2012, Page 193

PY - 2012/5

Y1 - 2012/5

N2 - Context Renal cell carcinoma (RCC) accounts for 2–3% of adult malignancies. There remain uncertainties over the oncological outcomes for the surgical management of localised RCC. Objective Systematically review relevant literature comparing oncological outcomes of surgical management of localised RCC (T1–2N0M0). Evidence acquisition Relevant databases including Medline, Embase, and the Cochrane Library were searched up to October 2010, and an updated scoping search was performed up to January 2012. Randomised controlled trials (RCTs) or quasi-RCTs, prospective observational studies with controls, retrospective matched-pair studies, and comparative studies from well-defined registries/databases were included. The main outcomes were overall survival, cancer-specific survival, recurrence, and metastases. The Cochrane risk of bias tool was used to assess RCTs, and an extended version was used to assess nonrandomised studies (NRSs). The quality of evidence was assessed using Grading of Recommendations Assessment, Development, and Evaluation (GRADE). Evidence synthesis A total of 4580 abstracts and 389 full-text articles were assessed. Thirty-four studies met the inclusion criteria (6 RCTs and 28 NRSs). Meta-analyses were planned but were deemed inappropriate due to data heterogeneity. There were high risks of bias and low-quality evidence across the evidence base. Open radical nephrectomy and open partial nephrectomy showed similar cancer-specific and overall survival, but when both open and laparoscopic approaches are considered together, the evidence showed improved survival for partial nephrectomy for tumours =4 cm. The overall evidence suggests either equivalent or better survival with partial nephrectomy. Laparoscopic radical nephrectomy offered equivalent survival to open radical nephrectomy, and all laparoscopic approaches achieved equivalent survival. Open and laparoscopic partial nephrectomy achieved equivalent survival. The issue of ipsilateral adrenalectomy or complete lymph node dissection with radical nephrectomy or partial nephrectomy remains unresolved. Conclusions The evidence base suggests localised RCCs are best managed by nephron-sparing surgery where technically feasible. However, the current evidence base has significant limitations due to studies of low methodological quality marked by high risks of bias.

AB - Context Renal cell carcinoma (RCC) accounts for 2–3% of adult malignancies. There remain uncertainties over the oncological outcomes for the surgical management of localised RCC. Objective Systematically review relevant literature comparing oncological outcomes of surgical management of localised RCC (T1–2N0M0). Evidence acquisition Relevant databases including Medline, Embase, and the Cochrane Library were searched up to October 2010, and an updated scoping search was performed up to January 2012. Randomised controlled trials (RCTs) or quasi-RCTs, prospective observational studies with controls, retrospective matched-pair studies, and comparative studies from well-defined registries/databases were included. The main outcomes were overall survival, cancer-specific survival, recurrence, and metastases. The Cochrane risk of bias tool was used to assess RCTs, and an extended version was used to assess nonrandomised studies (NRSs). The quality of evidence was assessed using Grading of Recommendations Assessment, Development, and Evaluation (GRADE). Evidence synthesis A total of 4580 abstracts and 389 full-text articles were assessed. Thirty-four studies met the inclusion criteria (6 RCTs and 28 NRSs). Meta-analyses were planned but were deemed inappropriate due to data heterogeneity. There were high risks of bias and low-quality evidence across the evidence base. Open radical nephrectomy and open partial nephrectomy showed similar cancer-specific and overall survival, but when both open and laparoscopic approaches are considered together, the evidence showed improved survival for partial nephrectomy for tumours =4 cm. The overall evidence suggests either equivalent or better survival with partial nephrectomy. Laparoscopic radical nephrectomy offered equivalent survival to open radical nephrectomy, and all laparoscopic approaches achieved equivalent survival. Open and laparoscopic partial nephrectomy achieved equivalent survival. The issue of ipsilateral adrenalectomy or complete lymph node dissection with radical nephrectomy or partial nephrectomy remains unresolved. Conclusions The evidence base suggests localised RCCs are best managed by nephron-sparing surgery where technically feasible. However, the current evidence base has significant limitations due to studies of low methodological quality marked by high risks of bias.

KW - localised renal cance

KW - oncological outcomes

KW - radical nephrectomy

KW - adenalectomy

KW - lymphadenectomy

KW - partial nephrectomy

KW - nephron-sparing surgery

KW - cryoablation

KW - radiofrequency ablation

KW - HIFU

KW - systematic reviews

KW - meta-analysis

U2 - 10.1016/j.eururo.2012.02.039

DO - 10.1016/j.eururo.2012.02.039

M3 - Article

VL - 61

SP - 972

EP - 993

JO - European Urology

JF - European Urology

SN - 0302-2838

IS - 5

ER -