Systematic review of perioperative and quality-of-life outcomes following surgical management of localised renal cancer

Steven MacLennan, Mari Imamura, Marie C. Lapitan, Muhammad Imran Omar, Thomas B. L. Lam, Ana M. Hilvano-Cabungcal, Pam Royle, Fiona Stewart, Graeme MacLennan, Sara J. MacLennan, Philipp Dahm, Steven E. Canfield, Sam McClinton, T. R. Leyshon Griffiths, Börje Ljungberg, James N'Dow, UCAN Systematic Review Reference Group

Research output: Contribution to journalArticle

98 Citations (Scopus)
7 Downloads (Pure)

Abstract

Context
For the treatment of localised renal cell carcinoma (RCC), uncertainties remain over the perioperative and quality-of-life (QoL) outcomes for the many different surgical techniques and approaches of nephrectomy. Controversy also remains on whether newer minimally invasive nephron-sparing interventions offer better QoL and perioperative outcomes, and whether adrenalectomy and lymphadenectomy should be performed simultaneously with nephrectomy. These non-oncological outcomes are important because they may have a considerable impact on localised RCC treatment decision making.

Objective
To review systematically all the relevant published literature comparing perioperative and QoL outcomes of surgical management of localised RCC (T1–2N0M0).

Evidence acquisition
Relevant databases including Medline, Embase, and the Cochrane Library were searched up to January 2012. Randomised controlled trials (RCTs) or quasi-randomised controlled trials, prospective observational studies with controls, retrospective matched-pair studies, and comparative studies from well-defined registries/databases were included. The outcome measures were QoL, analgesic requirement, length of hospital stay, time to normal activity level, surgical morbidity and complications, ischaemia time, renal function, blood loss, length of operation, need for blood transfusion, and perioperative mortality. 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.

Evidence synthesis
A total of 4580 abstracts and 380 full-text articles were assessed, and 29 studies met the inclusion criteria (7 RCTs and 22 NRSs). There were high risks of bias and low-quality evidence for studies meeting the inclusion criteria. There is good evidence indicating that partial nephrectomy results in better preservation of renal function and better QoL outcomes than radical nephrectomy regardless of technique or approach. Regarding radical nephrectomy, the laparoscopic approach has better perioperative outcomes than the open approach, and there is no evidence of a difference between the transperitoneal and retroperitoneal approaches. Alternatives to standard laparoscopic radical nephrectomy (LRN) such as hand-assisted, robot-assisted, or single-port techniques appear to have similar perioperative outcomes. There is no good evidence to suggest that minimally invasive procedures such as cryotherapy or radiofrequency ablation have superior perioperative or QoL outcomes to nephrectomy. Regarding concomitant lymphadenectomy during nephrectomy, there were low event rates for complications, and no definitive difference was observed. There was no evidence to base statements about concomitant ipsilateral adrenalectomy during nephrectomy.

Conclusions
Partial nephrectomy results in significantly better preservation of renal function over radical nephrectomy. For tumours where partial nephrectomy is not technically feasible, there is no evidence that alternative procedures or techniques are better than LRN in terms of perioperative or QoL outcomes. In making treatment decisions, perioperative and QoL outcomes should be considered in conjunction with oncological outcomes. Overall, there was a paucity of data regarding QoL outcomes, and when reported, both QoL and perioperative outcomes were inconsistently defined, measured, or reported. The current evidence base has major limitations due to studies of low methodological quality marked by high risks of bias.
Original languageEnglish
Pages (from-to)1097-1117
Number of pages21
JournalEuropean Urology
Volume62
Issue number6
Early online date20 Jul 2012
DOIs
Publication statusPublished - Dec 2012

Fingerprint

Kidney Neoplasms
Nephrectomy
Quality of Life
Randomized Controlled Trials
Renal Cell Carcinoma
Adrenalectomy
Lymph Node Excision
Kidney
Length of Stay
Decision Making
Databases
Cryotherapy
Nephrons
Blood Transfusion
Libraries
Uncertainty
Observational Studies
Analgesics
Registries
Therapeutics

Keywords

  • localised renal cancer
  • perioperative and quality-of-life outcomes
  • radical nephrectomy
  • adrenalectomy
  • lymphadenectomy
  • partial nephrectomy
  • nephron-sparing surgery
  • cryoablation
  • radiofrequency ablation
  • HIFU
  • systematic reviews
  • meta-analysis

Cite this

Systematic review of perioperative and quality-of-life outcomes following surgical management of localised renal cancer. / MacLennan, Steven; Imamura, Mari; Lapitan, Marie C.; Omar, Muhammad Imran; Lam, Thomas B. L.; Hilvano-Cabungcal, Ana M.; Royle, Pam; Stewart, Fiona; MacLennan, Graeme; MacLennan, Sara J.; Dahm, Philipp; Canfield, Steven E.; McClinton, Sam; Griffiths, T. R. Leyshon; Ljungberg, Börje; N'Dow, James; UCAN Systematic Review Reference Group.

In: European Urology, Vol. 62, No. 6, 12.2012, p. 1097-1117.

Research output: Contribution to journalArticle

MacLennan, S, Imamura, M, Lapitan, MC, Omar, MI, Lam, TBL, Hilvano-Cabungcal, AM, Royle, P, Stewart, F, MacLennan, G, MacLennan, SJ, Dahm, P, Canfield, SE, McClinton, S, Griffiths, TRL, Ljungberg, B, N'Dow, J & UCAN Systematic Review Reference Group 2012, 'Systematic review of perioperative and quality-of-life outcomes following surgical management of localised renal cancer', European Urology, vol. 62, no. 6, pp. 1097-1117. https://doi.org/10.1016/j.eururo.2012.07.028
MacLennan, Steven ; Imamura, Mari ; Lapitan, Marie C. ; Omar, Muhammad Imran ; Lam, Thomas B. L. ; Hilvano-Cabungcal, Ana M. ; Royle, Pam ; Stewart, Fiona ; MacLennan, Graeme ; MacLennan, Sara J. ; Dahm, Philipp ; Canfield, Steven E. ; McClinton, Sam ; Griffiths, T. R. Leyshon ; Ljungberg, Börje ; N'Dow, James ; UCAN Systematic Review Reference Group. / Systematic review of perioperative and quality-of-life outcomes following surgical management of localised renal cancer. In: European Urology. 2012 ; Vol. 62, No. 6. pp. 1097-1117.
@article{be4b240f559c4c7c8f47a83e20feab9e,
title = "Systematic review of perioperative and quality-of-life outcomes following surgical management of localised renal cancer",
abstract = "ContextFor the treatment of localised renal cell carcinoma (RCC), uncertainties remain over the perioperative and quality-of-life (QoL) outcomes for the many different surgical techniques and approaches of nephrectomy. Controversy also remains on whether newer minimally invasive nephron-sparing interventions offer better QoL and perioperative outcomes, and whether adrenalectomy and lymphadenectomy should be performed simultaneously with nephrectomy. These non-oncological outcomes are important because they may have a considerable impact on localised RCC treatment decision making.ObjectiveTo review systematically all the relevant published literature comparing perioperative and QoL outcomes of surgical management of localised RCC (T1–2N0M0).Evidence acquisitionRelevant databases including Medline, Embase, and the Cochrane Library were searched up to January 2012. Randomised controlled trials (RCTs) or quasi-randomised controlled trials, prospective observational studies with controls, retrospective matched-pair studies, and comparative studies from well-defined registries/databases were included. The outcome measures were QoL, analgesic requirement, length of hospital stay, time to normal activity level, surgical morbidity and complications, ischaemia time, renal function, blood loss, length of operation, need for blood transfusion, and perioperative mortality. 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.Evidence synthesisA total of 4580 abstracts and 380 full-text articles were assessed, and 29 studies met the inclusion criteria (7 RCTs and 22 NRSs). There were high risks of bias and low-quality evidence for studies meeting the inclusion criteria. There is good evidence indicating that partial nephrectomy results in better preservation of renal function and better QoL outcomes than radical nephrectomy regardless of technique or approach. Regarding radical nephrectomy, the laparoscopic approach has better perioperative outcomes than the open approach, and there is no evidence of a difference between the transperitoneal and retroperitoneal approaches. Alternatives to standard laparoscopic radical nephrectomy (LRN) such as hand-assisted, robot-assisted, or single-port techniques appear to have similar perioperative outcomes. There is no good evidence to suggest that minimally invasive procedures such as cryotherapy or radiofrequency ablation have superior perioperative or QoL outcomes to nephrectomy. Regarding concomitant lymphadenectomy during nephrectomy, there were low event rates for complications, and no definitive difference was observed. There was no evidence to base statements about concomitant ipsilateral adrenalectomy during nephrectomy.ConclusionsPartial nephrectomy results in significantly better preservation of renal function over radical nephrectomy. For tumours where partial nephrectomy is not technically feasible, there is no evidence that alternative procedures or techniques are better than LRN in terms of perioperative or QoL outcomes. In making treatment decisions, perioperative and QoL outcomes should be considered in conjunction with oncological outcomes. Overall, there was a paucity of data regarding QoL outcomes, and when reported, both QoL and perioperative outcomes were inconsistently defined, measured, or reported. The current evidence base has major limitations due to studies of low methodological quality marked by high risks of bias.",
keywords = "localised renal cancer, perioperative and quality-of-life outcomes, radical nephrectomy, adrenalectomy, lymphadenectomy, partial nephrectomy, nephron-sparing surgery, cryoablation, radiofrequency ablation, HIFU, systematic reviews, meta-analysis",
author = "Steven MacLennan and Mari Imamura and Lapitan, {Marie C.} and Omar, {Muhammad Imran} and Lam, {Thomas B. L.} and Hilvano-Cabungcal, {Ana M.} and Pam Royle and Fiona Stewart and Graeme MacLennan and MacLennan, {Sara J.} and Philipp Dahm and Canfield, {Steven E.} and Sam McClinton and Griffiths, {T. R. Leyshon} and B{\"o}rje Ljungberg and James N'Dow and {UCAN Systematic Review Reference Group}",
note = "UCAN Cancer Charity (www.ucanhelp.org.uk) and MacMillan Cancer Charity (www.macmillan.org.uk) helped design and conduct the study.",
year = "2012",
month = "12",
doi = "10.1016/j.eururo.2012.07.028",
language = "English",
volume = "62",
pages = "1097--1117",
journal = "European Urology",
issn = "0302-2838",
publisher = "Elsevier",
number = "6",

}

TY - JOUR

T1 - Systematic review of perioperative and quality-of-life outcomes following surgical management of localised renal cancer

AU - MacLennan, Steven

AU - Imamura, Mari

AU - Lapitan, Marie C.

AU - Omar, Muhammad Imran

AU - Lam, Thomas B. L.

AU - Hilvano-Cabungcal, Ana M.

AU - Royle, Pam

AU - Stewart, Fiona

AU - MacLennan, Graeme

AU - MacLennan, Sara J.

AU - Dahm, Philipp

AU - Canfield, Steven E.

AU - McClinton, Sam

AU - Griffiths, T. R. Leyshon

AU - Ljungberg, Börje

AU - N'Dow, James

AU - UCAN Systematic Review Reference Group

N1 - UCAN Cancer Charity (www.ucanhelp.org.uk) and MacMillan Cancer Charity (www.macmillan.org.uk) helped design and conduct the study.

PY - 2012/12

Y1 - 2012/12

N2 - ContextFor the treatment of localised renal cell carcinoma (RCC), uncertainties remain over the perioperative and quality-of-life (QoL) outcomes for the many different surgical techniques and approaches of nephrectomy. Controversy also remains on whether newer minimally invasive nephron-sparing interventions offer better QoL and perioperative outcomes, and whether adrenalectomy and lymphadenectomy should be performed simultaneously with nephrectomy. These non-oncological outcomes are important because they may have a considerable impact on localised RCC treatment decision making.ObjectiveTo review systematically all the relevant published literature comparing perioperative and QoL outcomes of surgical management of localised RCC (T1–2N0M0).Evidence acquisitionRelevant databases including Medline, Embase, and the Cochrane Library were searched up to January 2012. Randomised controlled trials (RCTs) or quasi-randomised controlled trials, prospective observational studies with controls, retrospective matched-pair studies, and comparative studies from well-defined registries/databases were included. The outcome measures were QoL, analgesic requirement, length of hospital stay, time to normal activity level, surgical morbidity and complications, ischaemia time, renal function, blood loss, length of operation, need for blood transfusion, and perioperative mortality. 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.Evidence synthesisA total of 4580 abstracts and 380 full-text articles were assessed, and 29 studies met the inclusion criteria (7 RCTs and 22 NRSs). There were high risks of bias and low-quality evidence for studies meeting the inclusion criteria. There is good evidence indicating that partial nephrectomy results in better preservation of renal function and better QoL outcomes than radical nephrectomy regardless of technique or approach. Regarding radical nephrectomy, the laparoscopic approach has better perioperative outcomes than the open approach, and there is no evidence of a difference between the transperitoneal and retroperitoneal approaches. Alternatives to standard laparoscopic radical nephrectomy (LRN) such as hand-assisted, robot-assisted, or single-port techniques appear to have similar perioperative outcomes. There is no good evidence to suggest that minimally invasive procedures such as cryotherapy or radiofrequency ablation have superior perioperative or QoL outcomes to nephrectomy. Regarding concomitant lymphadenectomy during nephrectomy, there were low event rates for complications, and no definitive difference was observed. There was no evidence to base statements about concomitant ipsilateral adrenalectomy during nephrectomy.ConclusionsPartial nephrectomy results in significantly better preservation of renal function over radical nephrectomy. For tumours where partial nephrectomy is not technically feasible, there is no evidence that alternative procedures or techniques are better than LRN in terms of perioperative or QoL outcomes. In making treatment decisions, perioperative and QoL outcomes should be considered in conjunction with oncological outcomes. Overall, there was a paucity of data regarding QoL outcomes, and when reported, both QoL and perioperative outcomes were inconsistently defined, measured, or reported. The current evidence base has major limitations due to studies of low methodological quality marked by high risks of bias.

AB - ContextFor the treatment of localised renal cell carcinoma (RCC), uncertainties remain over the perioperative and quality-of-life (QoL) outcomes for the many different surgical techniques and approaches of nephrectomy. Controversy also remains on whether newer minimally invasive nephron-sparing interventions offer better QoL and perioperative outcomes, and whether adrenalectomy and lymphadenectomy should be performed simultaneously with nephrectomy. These non-oncological outcomes are important because they may have a considerable impact on localised RCC treatment decision making.ObjectiveTo review systematically all the relevant published literature comparing perioperative and QoL outcomes of surgical management of localised RCC (T1–2N0M0).Evidence acquisitionRelevant databases including Medline, Embase, and the Cochrane Library were searched up to January 2012. Randomised controlled trials (RCTs) or quasi-randomised controlled trials, prospective observational studies with controls, retrospective matched-pair studies, and comparative studies from well-defined registries/databases were included. The outcome measures were QoL, analgesic requirement, length of hospital stay, time to normal activity level, surgical morbidity and complications, ischaemia time, renal function, blood loss, length of operation, need for blood transfusion, and perioperative mortality. 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.Evidence synthesisA total of 4580 abstracts and 380 full-text articles were assessed, and 29 studies met the inclusion criteria (7 RCTs and 22 NRSs). There were high risks of bias and low-quality evidence for studies meeting the inclusion criteria. There is good evidence indicating that partial nephrectomy results in better preservation of renal function and better QoL outcomes than radical nephrectomy regardless of technique or approach. Regarding radical nephrectomy, the laparoscopic approach has better perioperative outcomes than the open approach, and there is no evidence of a difference between the transperitoneal and retroperitoneal approaches. Alternatives to standard laparoscopic radical nephrectomy (LRN) such as hand-assisted, robot-assisted, or single-port techniques appear to have similar perioperative outcomes. There is no good evidence to suggest that minimally invasive procedures such as cryotherapy or radiofrequency ablation have superior perioperative or QoL outcomes to nephrectomy. Regarding concomitant lymphadenectomy during nephrectomy, there were low event rates for complications, and no definitive difference was observed. There was no evidence to base statements about concomitant ipsilateral adrenalectomy during nephrectomy.ConclusionsPartial nephrectomy results in significantly better preservation of renal function over radical nephrectomy. For tumours where partial nephrectomy is not technically feasible, there is no evidence that alternative procedures or techniques are better than LRN in terms of perioperative or QoL outcomes. In making treatment decisions, perioperative and QoL outcomes should be considered in conjunction with oncological outcomes. Overall, there was a paucity of data regarding QoL outcomes, and when reported, both QoL and perioperative outcomes were inconsistently defined, measured, or reported. The current evidence base has major limitations due to studies of low methodological quality marked by high risks of bias.

KW - localised renal cancer

KW - perioperative and quality-of-life outcomes

KW - radical nephrectomy

KW - adrenalectomy

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.2012.07.028

DO - 10.1016/j.eururo.2012.07.028

M3 - Article

VL - 62

SP - 1097

EP - 1117

JO - European Urology

JF - European Urology

SN - 0302-2838

IS - 6

ER -