Investigative and Clinical Urology (Mar 2022)

Tumor enucleation for the treatment of T1 renal tumors: A systematic review and meta-analysis

  • Hyun Chul Chung,
  • Tae Wook Kang,
  • Joon Young Lee,
  • Eu Chang Hwang,
  • Hong Jun Park ,
  • Jun Eul Hwang,
  • Ki Don Chang ,
  • Young Hwan Kim ,
  • Jae Hung Jung

DOI
https://doi.org/10.4111/icu.20210361
Journal volume & issue
Vol. 63, no. 2
pp. 126 – 139

Abstract

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Purpose: To evaluate the clinical efficacy and safety of tumor enucleation (TE) compared with partial nephrectomy (PN) for T1 renal cell carcinoma. Materials and Methods: According to protocol, we searched multiple data sources for published and unpublished randomized controlled trials and nonrandomized studies (NRSs) in any language. We performed systematic review and meta-analysis according to the Cochrane Handbook for Systematic Reviews of Interventions and rated the certainty of the evidence (CoE) using the GRADE framework. Results: We are uncertain about the effects of TE on perioperative (mean difference [MD] 3.38, 95% CI 1.52 to 5.23; I2=68%; 4 NRSs; 942 participants; very low CoE) and long-term (MD 2.31, 95% CI -1.40 to 6.01; I2=57%; 4 NRSs; 542 participants; very low CoE) residual renal function. TE may result in little to no difference in short-term residual renal function (MD 1.04, 95% CI 0.25 to 1.83; I2=0%; 2 NRSs; 256 participants; low CoE). We are uncertain about the effects of TE on cancer-specific mortality (risk ratio [RR] 0.90, 95% CI: 0.11 to 7.28; I2=0%; 2 NRSs; 551 participants; very low CoE) and major adverse events (RR 0.48, 95% CI: 0.30 to 0.79; I2=0%; 10 NRS; 2,360 participants; very low CoE). Conclusions: While TE appears to have similar effects on short term postoperative residual renal function, there were uncertainties on mortality and major adverse events. However, we need rigorous RCTs to elucidate the effects of TE as the evidence stems mostly from NRSs.

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