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

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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

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Keywords

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

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