Review – Kidney CancerSystematic Review of Perioperative and Quality-of-life Outcomes Following Surgical Management of Localised Renal Cancer
Introduction
Nephron-sparing surgery (ie, partial nephrectomy) and other minimally invasive interventions such as cryoablation, radiofrequency ablation (RFA), and high-intensity focussed ultrasound (HIFU) are alternative options to radical nephrectomy in the management of localised (T1–2N0M0) renal cell carcinoma (RCC) [1], [2], [3], [4], [5], [6], [7]. Although the decision to undertake these procedures is usually oncologically driven, there is a definite need for a better understanding of non-oncological outcomes associated with these competing interventions because they influence treatment decision making. Various guidelines presently exist in relation to the various interventions for localised RCC [1], [5]. However, it is important to recognise that many current urology guidelines recommendations are not based on systematic reviews of the evidence [8]. Consequently, a systematic review of current evidence is urgently needed to establish whether the non-oncological outcomes of all these competing interventions are comparable. Such a review should be performed with methodological rigour in assessing risks of bias and quality of evidence in a standardised and transparent way to highlight potential weaknesses in the evidence base and highlight areas for future research.
The objective of this systematic review was to compare the perioperative and quality-of-life (QoL) outcomes for all interventions relevant to the management of localised RCC. The oncological outcomes of the review are copublished in a separate article [9]. There is also a full report published online [10] with extra methodological information and data for oncological and surgical (non-oncological) outcomes.
Section snippets
Search strategy
The search was conducted in accordance with the principles outlined in the Cochrane Handbook of Systematic Reviews [11]. The databases searched were Medline (1950–October 2010) and Embase (1980–October 2010), Cochrane Library, all sections (issue 4, 2010), Web of Science with conference proceedings (1970–October 2010), and American Society of Clinical Oncology meeting abstracts (up to October 2010). The searches were not limited by language. Auto-alerts in Medline and Embase were also run
Risk of bias and quality assessment of the included studies
The study selection process is outlined in the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) diagram (Fig. 1). There were 39 studies that met the inclusion criteria, 28 (72%) of which reported surgical outcomes, of which only 7 (25%) were RCTs. The Cochrane RoB assessment can be viewed in the appendix. The additional nonrandomised risk of bias assessment adjustment scores (outlined earlier) are displayed in Table 1, which reports baseline characteristics (all study
Conclusions
In terms of perioperative and QoL outcomes, partial nephrectomy results in significantly better preservation of renal function over radical nephrectomy regardless of choice of approach or technique. For tumours where partial nephrectomy is not technically feasible (eg, tumours >4 cm), there is no evidence that alternative procedures or techniques are better than LRN, which is the standard of care for these localised tumours. For LRN, the choice of approach (eg, transperitoneal or
References (61)
- et al.
Nephron-sparing surgery for localized renal cell carcinoma with a normal contralateral kidney: a European three-center experience
Urology
(2002) - et al.
Nephron-sparing surgery as the new gold standard for T1 <= 7 cm renal cell carcinoma: results of a contemporary UCLA series
J Urol
(2004) - et al.
EAU guidelines on renal cell carcinoma: the 2010 update
Eur Urol
(2010) - et al.
Nephron sparing surgery for renal tumors: indications, techniques and outcomes
J Urol
(2001) - et al.
The future of clinical practice guidelines in urology
Eur Urol
(2011) - et al.
Systematic review of oncological outcomes following surgical management of localised renal cancer
Eur Urol
(2012) - et al.
Laparoscopic versus open radical nephrectomy for large renal tumors: a long-term prospective comparison
J Urol
(2007) - et al.
Prospective randomized comparison of transperitoneal versus retroperitoneal laparoscopic radical nephrectomy
J Urol
(2005) - et al.
Prospective, randomized controlled study: transperitoneal laparoscopic versus retroperitoneoscopic radical nephrectomy
Urology
(2004) - et al.
Approach and specimen handling do not influence oncological perioperative and long-term outcomes after laparoscopic radical nephrectomy
J Urol
(2009)