1887
Volume 2025, Issue 2
  • ISSN: 0253-8253
  • E-ISSN: 2227-0426

Surgical intervention remains the primary treatment for localized renal tumors and masses, with partial nephrectomy (PN) and radical nephrectomy (RN) being the two most frequently employed procedures. The choice between these approaches is often influenced by factors such as tumor size, location, histology, and patient comorbidities. However, the decision between PN and RN remains a subject of ongoing debate, particularly as emerging evidence suggests varying outcomes based on the stage and type of renal tumors. This meta-analysis evaluates the association between renal tumor stage and subtype with the outcomes of PN and RN, focusing on renal function, cancer-specific survival, and postoperative complications.

An exhaustive search was conducted across PubMed, Scopus, and Embase databases, covering the literature from their inception up to March 2023, in accordance with the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines. Original studies comparing PN to RN in the management of renal tumors at various stages were meticulously screened, adhering to stringent inclusion and exclusion criteria. This protocol was registered on PROSPERO (CRD42023455985).

Overall, 38 cohort studies were included, with a total of 144,608 patients diagnosed with renal cancer who underwent nephrectomy, 71,582 who underwent PN, and 72,671 who underwent RN. The data revealed a significant difference in cancer-specific survival between PN and RN, which was higher in the RN group (pooled HR: 1.17; 95% CI = 1.01–1.35) < 0.001. The postoperative renal function of patients who underwent RN was worse than that of patients who underwent PN (pooled RR: 4.22; 95% CI: 1.45, 12.27, < 0.00001). The relative risk of papillary renal cell carcinoma (RCC) was lower in patients who underwent RN as compared to PN (the pooled RR, 1.32; 95% CI = 1.02, 1.72, < 0.001), while the relative risk of RCC collecting duct subtype was significantly lower patients who underwent PN as compared to RN (the pooled RR, 0.44 (95% CI = 0.29, 0.67) = 0.97. Additionally, the pooled risk for patients with a Charlson Comorbidity Index score of ≥2 was lower in the PN group compared to the RN group.

Across various tumor stages, RN demonstrates superior cancer-specific survival, and a lower incidence of postoperative complications compared to PN. However, PN is associated with more favorable renal function preservation. These findings, in conjunction with individual patient characteristics, should be meticulously evaluated to inform the selection of the most appropriate surgical approach and guide patient counseling.

© 2025 Al-Qudimat, Altahtamouni, Elaarag, Singh, Abdelrahman, Khalil, et al., licensee HBKU Press.
Loading

جارٍ تحميل قياسات المقالة...

/content/journals/10.5339/qmj.2025.54
٢٠٢٥-٠٦-٠٩
٢٠٢٥-١٢-١٩

القياسات

Loading full text...

Full text loading...

/deliver/fulltext/qmj/2025/2/qmj.2025.54.html?itemId=/content/journals/10.5339/qmj.2025.54&mimeType=html&fmt=ahah

References

  1. Lopez-Beltran A, Scarpelli M, Montironi R, Kirkali Z. 2004 WHO classification of the renal tumors of the adults. Eur Urol. 2006; 49:(5):798–805.
    [Google الباحث العلمي]
  2. WHO. International Agency for Research on Cancer WHO. Cancer Today; 2020
     [Google الباحث العلمي]
  3. WHO. Internatioanl Agency for Reserch on Cancer WHO. Kidney fact sheet; 2020.
    [Google الباحث العلمي]
  4. Ljungberg B, Albiges L, Abu-Ghanem Y, Bedke J, Capitanio U, Dabestani S, et al.. European Association of Urology guidelines on renal cell carcinoma: the 2022 update. Eur Urol. 2022; 82:(4):399–410.
    [Google الباحث العلمي]
  5. Miller DC, Schonlau M, Litwin MS, Lai J, Saigal CS. Renal and cardiovascular morbidity after partial or radical nephrectomy. Cancer. 2008; 112:(3):511–20.
    [Google الباحث العلمي]
  6. Van Poppel H, Da Pozzo L, Albrecht W, Matveev V, Bono A, Borkowski, A, et al.. A prospective, randomised EORTC intergroup phase 3 study comparing the oncologic outcome of elective nephron-sparing surgery and radical nephrectomy for low-stage renal cell carcinoma. Eur Urol. 2011; 59:(4):543–52.
    [Google الباحث العلمي]
  7. Deng H, Fan Y, Yuan F, Wang L, Hong Z, Zhan J, et al.. Partial nephrectomy provides equivalent oncologic outcomes and better renal function preservation than radical nephrectomy for pathological T3a renal cell carcinoma: a meta-analysis. Int Braz J Urol. 2021; 47:(1):46–60.
    [Google الباحث العلمي]
  8. Jiang YL, Peng CX, Wang HZ, Qian LJ. Comparison of the long-term follow-up and perioperative outcomes of partial nephrectomy and radical nephrectomy for 4 cm to 7 cm renal cell carcinoma: a systematic review and meta-analysis. BMC Urol. 2019; 19:(1):48.
    [Google الباحث العلمي]
  9. Mir MC, Derweesh I, Porpiglia F, Zargar H, Mottrie A, Autorino R. Partial nephrectomy versus radical nephrectomy for clinical T1b and T2 renal tumors: a systematic review and meta-analysis of comparative studies. Eur Urol. 2017; 71:(4):606–17.
    [Google الباحث العلمي]
  10. Huang R, Zhang C, Wang X, Hu H. Partial Nephrectomy versus radical nephrectomy for clinical T2 or higher stage renal tumors: a systematic review and meta-analysis. Front Oncol. 2021; 11:680842.
    [Google الباحث العلمي]
  11. Gorin MA, Ball MW, Pierorazio PM, Tanagho YS, Bhayani SB, Kaouk JH, et al.. Outcomes and predictors of clinical T1 to pathological T3a tumor up-staging after robotic partial nephrectomy: a multi-institutional analysis. J Urol. 2013; 190:(5):1907–11.
    [Google الباحث العلمي]
  12. Kim SP, Shah ND, Weight CJ, Thompson RH, Moriarty JP, Shippee ND, et al.. Contemporary trends in nephrectomy for renal cell carcinoma in the United States: results from a population based cohort. J Urol. 2011; 186:(5):1779–85.
    [Google الباحث العلمي]
  13. Leppert JT, Mittakanti HR, Thomas IC, Lamberts RW, Sonn GA, Chung BI, et al.. Contemporary use of partial nephrectomy: are older patients with impaired kidney function being left behind?Urology. 2017; 100:65–71.
    [Google الباحث العلمي]
  14. Moher D, Liberati A, Tetzlaff J, Altman DG. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Int J Surg. 2010; 8:(5):336–41.
    [Google الباحث العلمي]
  15. Peters JL, Sutton AJ, Jones DR, Abrams KR, Rushton L. Comparison of two methods to detect publication bias in meta-analysis. JAMA. 2006; 295:(6):676–80.
    [Google الباحث العلمي]
  16. Wells G, Shea B, O’Connell J, Robertson J, Peterson V, Welch V. The NewcastleOttawa scale (NOS) for assessing the quality of nonrandomised studies in meta-analysis. OHIA. 2016(clinical_epidemiology).
    [Google الباحث العلمي]
  17. Kopp RP, Liss MA, Mehrazin R, Palazzi K, Vourganti S, Ristau B, et al.. Analysis of renal functional outcomes after radical or partial nephrectomy for renal masses ≥7 cm using the RENAL score. Urology. 2015; 86:(2):312–9.
    [Google الباحث العلمي]
  18. Vilaseca A, Guglielmetti G, Vertosick EA, Sjoberg DD, Ehdaie B, Touijer KA, et al.. Value of partial nephrectomy for renal cortical tumors of cT2 or greater stage: a risk-benefit analysis of renal function preservation versus increased postoperative morbidity. Eur Urol Oncol. 2020; 3:(3):365–71.
    [Google الباحث العلمي]
  19. Breau RH, Crispen PL, Jimenez RE, Lohse CM, Blute ML, Leibovich BC. Outcome of stage T2 or greater renal cell cancer treated with partial nephrectomy. J Urol. 2010; 183:(3):903–8.
    [Google الباحث العلمي]
  20. Roos FC, Brenner W, Thomas C, Hampel C, Becker F, Thüroff JW, et al.. Functional analysis of elective nephron-sparing surgery vs radical nephrectomy for renal tumors larger than 4 cm. Urology. 2012; 79:(3):607–13.
    [Google الباحث العلمي]
  21. Shum CF, Bahler CD, Sundaram CP. Matched comparison between partial nephrectomy and radical nephrectomy for T2 N0 M0 tumors, a study based on the National Cancer Database. J Endourol. 2017; 31:(8):800–5.
    [Google الباحث العلمي]
  22. Chong JT, Paulucci D, Lubin M, Kates M, Sfakianos JP, Badani KK, et al.. Comparison of overall survival and unplanned hospital readmissions between partial and radical nephrectomy for cT1a and cT1b renal masses. Ther Adv Urol. 2018; 10:(12):383–91.
    [Google الباحث العلمي]
  23. Janicic A, Bumbasirevic U, Pekomezovic T, Djokic M, Acimovic M, Zdravkovic D, et al.. Partial versus radical nephrectomy for pT1a renal cancer in Serbia. JBUON. 2016; 21:1449–53.
    [Google الباحث العلمي]
  24. Talenfeld AD, Gennarelli RL, Elkin EB, Atoria CL, Russo P, Coleman JA, et al.. Percutaneous ablation versus partial and radical nephrectomy for T1a renal cancer: a population-based analysis. Ann Intern Med. 2018; 169:(2):69–77.
    [Google الباحث العلمي]
  25. Gershman B, Thompson RH, Boorjian SA, Lohse CM, Costello BA, Cheville JC, et al.. Radical versus partial nephrectomy for cT1 renal cell carcinoma. Eur Urol. 2018; 74:(6):825–32.
    [Google الباحث العلمي]
  26. Chung JS, Son NH, Lee SE, Byun SS, Hong SK, Lee HJ, et al.. Partial versus radical nephrectomy for T1–T2 renal cell carcinoma in patients with chronic kidney disease stage III: a multiinstitutional analysis of kidney function and survival rate. J Korean Med Sci. 2018; 33:(43):e277.
    [Google الباحث العلمي]
  27. Klett DE, Tsivian M, Packiam VT, Johnson SC, Viers BR, Inman BA, et al.. Partial versus radical nephrectomy in clinical T2 renal masses. Int J Urol. 2021; 28:(11):1149–54.
    [Google الباحث العلمي]
  28. Liu S, Feng C, Liu C, Wang Z. Comparison of prognosis between patients undergoing radical nephrectomy versus partial nephrectomy for renal cell carcinoma ≤7cm T3aN0/xM0: survival benefit is biased toward partial nephrectomy. Cancer Med. 2021; 10:(24):8909–23.
    [Google الباحث العلمي]
  29. Margulis V, Tamboli P, Jacobsohn KM, Swanson DA, Wood CG. Oncological efficacy and safety of nephron-sparing surgery for selected patients with locally advanced renal cell carcinoma. BJU Int. 2007; 100:(6):1235–9.
    [Google الباحث العلمي]
  30. de Saint Aubert N, Audenet F, McCaig F, Peyronnet B, Chartier-Kastler E, Rouprêt M, et al.. Nephron sparing surgery in tumours greater than 7 cm. Prog Urol. 2018; 28:(6):336–43.
    [Google الباحث العلمي]
  31. Brewer K, O’Malley RL, Hayn M, Stegemann AP, Smith L, Schwaab T, et al.. Perioperative and renal function outcomes of minimally invasive partial nephrectomy for T1b and T2a kidney tumors. J Endourol. 2012; 26:(3):244–8.
    [Google الباحث العلمي]
  32. Janssen MWW, Linxweiler J, Terwey S, Titze U, Wullich B, Hakenberg OW, et al.. Survival outcomes in patients with large (≥7 cm) clear cell renal cell carcinomas treated with nephron-sparing surgery versus radical nephrectomy: results of a multicenter cohort with long-term follow-up. PLoS One. 2018; 13:(5):e0196427.
    [Google الباحث العلمي]
  33. Abu-Ghanem Y, Powles T, Capitanio U, Klatte T, Bex A, Motzer RJ, et al.. Should patients with low-risk renal cell carcinoma be followed differently after nephron-sparing surgery vs radical nephrectomy?BJU Int. 2021; 128:(3):386–94.
    [Google الباحث العلمي]
  34. Pecoraro A, Amparore D, Manfredi M, Piramide F, De Cillis S, Fiori C, et al.. Partial vs. radical nephrectomy in non-metastatic pT3a kidney cancer patients: a population-based study. Minerva Urol Nephrol. 2022; 74:(4):445–51.
    [Google الباحث العلمي]
  35. Amparore D, Pecoraro A, Piramide F, Manfredi M, De Cillis S, Fiori C, et al.. Comparison between minimally-invasive partial and radical nephrectomy for the treatment of clinical T2 renal masses: results of a 10-year study in a tertiary care center. Minerva Urol Nephrol. 2021; 73:(4):509–17.
    [Google الباحث العلمي]
  36. Roussel E, Laenen A, Bhindi B, Lebacle C, Helleman J, De Bruyne S, et al.. Predicting short- and long-term renal function following partial and radical nephrectomy. Urol Oncol. 2023; 41:(2):110.e111–6.
    [Google الباحث العلمي]
  37. Kim H, Kim JK, Ye C, Lee J, Park JW, Han WK, et al.. Recurrence after radical and partial nephrectomy in high complex renal tumor using propensity score matched analysis. Sci Rep. 2021; 11:(1):2919.
    [Google الباحث العلمي]
  38. Lam JKJ, Tan SY, Chong KT. Is partial nephrectomy worth performing compared to radical nephrectomy for small, localised renal cortical tumours in geriatric patients?Singapore Med J. 2020; 61:(4):190–3.
    [Google الباحث العلمي]
  39. Mühlbauer J, Kowalewski KF, Walach MT, Nickel F, Müller S, Mihaljevic AL, et al.. Partial nephrectomy preserves renal function without increasing the risk of complications compared with radical nephrectomy for renal cell carcinomas of stages pT2–3a. Int J Urol. 2020; 27:(10):906–13.
    [Google الباحث العلمي]
  40. Kun Yu, Meiping Liu, Zhenguo Xie, Zhihai Yu, Liu S. Comparison of efficacy and long-term survival of laparoscopic radical nephrectomy with partial nephrectomy in the treatment of patients with early renal cell carcinoma. JBUON. 2020; 25:(2):1155–60.
    [Google الباحث العلمي]
  41. Luis-Cardo A, Herranz-Amo F, Rodríguez-Cabero M, Gómez A, Aliaga S, Montesinos M, et al.. Laparoscopic nephron sparing surgery and radical nephrectomy in cT1 renal tumors. Comparative analysis of complications and survival. Actas Urol Esp (Engl Ed). 2022; 46:(6):340–7.
    [Google الباحث العلمي]
  42. Nayan M, Saarela O, Lawson K, Martin L, Komisarenko M, Finelli A. Long-term outcomes after radical or partial nephrectomy for T1a renal cell carcinoma: a population-based study. Can Urol Assoc J. 2020; 14:(12):392–7.
    [Google الباحث العلمي]
  43. Siev M, Renson A, Tan HJ, Mano R, Palese MA, Lendvay TS, et al.. Prognostic value of histologic subtype and treatment modality for T1a kidney cancers. Kidney Cancer. 2020; 4:(1):49–58.
    [Google الباحث العلمي]
  44. Amer M, Selim M, Elshazly M, Sultan S. Partial nephrectomy versus radical nephrectomy for localized renal masses: critical analysis of oncological outcome and impact on the renal function. Egypt J Hosp Med. 2021; 84:(1):2262–9.
    [Google الباحث العلمي]
  45. Maric P, Aleksic P, Kosevic B, Vuksanovic A, Djordjevic D, Vucetic J, et al.. Comparison of oncologic outcomes between elective partial and radical nephrectomy in patients with renal cell carcinoma in CT1B stadium. Vojnosanit Pregl. 2022; 79:(6):591–8.
    [Google الباحث العلمي]
  46. Alvim R, Tin A, Nogueira L, Pinto P, Soares J, Castro M, et al.. A comparison of oncologic and functional outcomes in patients with pt3a renal cell carcinoma treated with partial and radical nephrectomy. Int Braz J Urol. 2021; 47:(4):777–83.
    [Google الباحث العلمي]
  47. Breau RH, Kapoor A, Nash DM, Fergusson D, Cadeddu JA, Berman DM, et al.. Partial vs. radical nephrectomy and the risk of all-cause mortality, cardiovascular, and nephrological outcomes. Can Urol Assoc J. 2020; 14:(10):337–45.
    [Google الباحث العلمي]
  48. Hori S, Tanaka N, Iida K, Yoshida S, Nin M, Matsumoto K, et al.. Impact of radical nephrectomy and partial nephrectomy on actual estimated overall survival compared to life expectancy in patients with renal cell carcinoma. Res Rep Urol. 2021; 13:155–65.
    [Google الباحث العلمي]
  49. Xiong S, Jiang M, Jiang Y, Wu H, Xu Y, Huang Y, et al.. Partial nephrectomy versus radical nephrectomy for endophytic renal tumors: comparison of operative, functional, and oncological outcomes by propensity score matching analysis. Front Oncol. 2022; 12:916018.
    [Google الباحث العلمي]
  50. Patel SH, Uzzo RG, Larcher A, Ristau BT, Lebastchi AH, Reese AC, et al.. Oncologic and functional outcomes of radical and partial nephrectomy in pT3a pathologically upstaged renal cell carcinoma: a multi-institutional analysis. Clin Genitourin Cancer. 2020; 18:(6):e723–9.
    [Google الباحث العلمي]
  51. Izol V, Gokalp F, Sozen S, Demirel C, Ozturk A, Ucar R, et al.. Factors affecting long-term renal functions after partial vs radical nephrectomy for clinical T1 renal masses: a multicentre study of the urooncology association, Turkey. Int J Clin Pract. 2021; 75:(5):e13960.
    [Google الباحث العلمي]
  52. Liu X, Huang X, Zhao P, Zhang P. Survival benefit of nephron-sparing surgery for patients with pT1b renal cell carcinoma: a population-based study. Oncol Lett. 2020; 19:(1):498–504.
    [Google الباحث العلمي]
  53. Zhang X, Su Z, Lv P, Liu Z, Bai S. Functional, oncological outcomes and safety of nephron-sparing surgery versus radical nephrectomy in patients with localised renal cell carcinoma with high anatomical complexity: a retrospective cohort study with propensity score matching method. BMJ Open. 2021; 11:(12):e051622.
    [Google الباحث العلمي]
  54. Partin AW, Kavoussi LR, Peters CA, Dmochowski RR. Campbell Walsh Wein handbook of urology. Philadelphia, PA: Elsevier; 2022.
    [Google الباحث العلمي]
  55. Van Poppel H, Da Pozzo L, Albrecht W, Matveev V, Bono A, Borkowski A, et al.. A prospective randomized EORTC intergroup phase 3 study comparing the complications of elective nephron-sparing surgery and radical nephrectomy for low-stage renal cell carcinoma. Eur Urol. 2007; 51:(6):1606–15.
    [Google الباحث العلمي]
  56. Kopp RP, Mehrazin R, Palazzi KL, Patterson AL, Soon SJ, Ramaswamy K, et al.. Survival outcomes after radical and partial nephrectomy for clinical T2 renal tumours categorised by R.E.N.A.L. nephrometry score. BJU Int. 2014; 114:(5):708–18.
    [Google الباحث العلمي]
  57. Bigot P, Hetet JF, Bernhard JC, Boillot B, Hupertan V, Bastide C, et al.. Nephron-sparing surgery for renal tumors measuring more than 7 cm: morbidity, and functional and oncological outcomes. Clin Genitourin Cancer. 2014; 12:(1):e19–27.
    [Google الباحث العلمي]
  58. Alanee S, Nutt M, Moore A, Murugan P, Gild P, Flack C, et al.. Partial nephrectomy for T2 renal masses: contemporary trends and oncologic efficacy. Int Urol Nephrol. 2015; 47:(6):945–50.
    [Google الباحث العلمي]
  59. Breau Rodney H, Crispen Paul L, Jimenez Rafael E, Lohse Christine M, Blute Michael L, Leibovich Bradley C. Outcome of stage T2 or greater renal cell cancer treated with partial nephrectomy. J Urol. 2010; 183:(3):903–8.
    [Google الباحث العلمي]
  60. Edge SB, Compton CC. The American Joint Committee on Cancer: the 7th edition of the AJCC cancer staging manual and the future of TNM. Ann Surg Oncol. 2010; 17:(6):1471–4.
    [Google الباحث العلمي]
  61. Keegan KA, Schupp CW, Chamie K, Hellenthal NJ, Evans CP, Koppie TM. Histopathology of surgically treated renal cell carcinoma: survival differences by subtype and stage. J Urol. 2012; 188:(2):391–7.
    [Google الباحث العلمي]
  62. Patel HD, Mullins JK, Pierorazio PM, Gorin MA, Allaf ME, Hyams ES, et al.. Trends in renal surgery: robotic technology is associated with increased use of partial nephrectomy. J Urol. 2013; 189:(4):1229–35.
    [Google الباحث العلمي]
  63. Xia L, Wang X, Xu T, Guzzo TJ. Systematic review and meta-analysis of comparative studies reporting perioperative outcomes of robot-assisted partial nephrectomy versus open partial nephrectomy. J Endourol. 2016; 31:(9):893–909.
    [Google الباحث العلمي]
  64. Lane Brian R, Campbell Steven C, Gill Inderbir S. 10-year oncologic outcomes after laparoscopic and open partial nephrectomy. J Urol. 2013; 190:(1):44–9.
    [Google الباحث العلمي]
/content/journals/10.5339/qmj.2025.54
Loading
Surgical Strategies in Renal Cancer: A Meta-analysis of Partial vs. Radical Nephrectomy Outcomes Across Tumor Stages
Qatar Medical Journal 2025, 54 (٢٠٢٥); https://doi.org/10.5339/qmj.2025.54
/content/journals/10.5339/qmj.2025.54
/content/journals/10.5339/qmj.2025.54
Loading

جارٍ تحميل البيانات والوسائط...

  • نوع المستند: Review Article
الموضوعات الرئيسية Kidney neoplasms, mortality, neoplasm staging, nephrectomy, partial nephrectomy, postoperative complications, radical nephrectomy, renal cell carcinoma and treatment outcome

الأكثر اقتباسًا لهذا الشهر Most Cited RSS feed

هذه الخانة مطلوبة
يُرجى إدخال عنوان بريد إلكتروني صالح
Approval was a Success
Invalid data
An Error Occurred
Approval was partially successful, following selected items could not be processed due to error