Comparison Of The Efficacy And Safety Of Partial Nephrectomy And Radical Nephrectomy For Clinical T1b And T2 Renal Tumors:A Meta-analysis

Objective:To systematically review the efficacy and safety of partial nephrectomy(PN)and radical nephrectomy(RN)for T1 b and T2 renal tumor.Methods:Databases including Pubmed、The Cochrane Library、EMbase、ScienceDirect、Web of science、CBM、CNKI、VIP and WangFang Dataf for clinical studies comparing partial nephrectomy(PN)and radical nephrectomy(RN)for T1 b or T2 renal tumor from 1990 to August,2018.Develop inclusion criteria and exclusion criteria,evaluate the quality of the literature and extract valid data.Complete the meta-analysis process using the RevMan5.3 software provided by Cochrane network.Results:15 studies including 6647 patients were deem eligible and included in the analysis,1667 patients with partial nephrectomy and 4980 patients with radical nephrectomy.Tumor in patients undergoing partial nephrectomy were smaller than those inpatients undergoing radical nephrectomy(MD-0.56,95%CI rang-0.67 to-0.45,P <0.00001))and patients undergoing partial nephrectomy were younger(MD-2.12,95%CI rang-2.4 to-1.83,P <0.00001).Patients with partial nephrectomy and patients undergoing radical nephrectomy had no difference in intraoperative complications(OR 1.66,95%CI rang0.83 to 3.28,P =0.15),but patients undergoing radical nephrectomy had fewer postoperative complications(OR 1.8,95%CI rang 1.28 to 2.53,P =0.0007).Theproportion of malignant histology in patients with partial nephrectomy was less than that in patients with radical nephrectomy(OR 0.45,95%CI rang 0.34 to 0.58,P <0.00001).GFR after surgery in patients with partial nephrectomy was higher than in patients undergoing radical nephrectomy(MD 13.05,95%CI rang 10.67 to 15.43,P<0.00001).Tumor recurrent rate of patients with partial nephrectomy was lower than than of patients undergoing radical nephrectomy(OR 0.47,95%CI rang 0.32 to 0.69,P<0.0001),tumor-special mortality was lower than patients with radical nephrectomy(OR0.61,95%CI rang 0.39 to 0.96,P =0.03),all-cause mortality was also lower than patients with radical nephrectomy(OR 0.63,95%CI rang 0.5 to 0.79,P<0.0001).Because there was a heterogeneity between the various studies,the indicators that can not be combined had operation time、intraoperative blood loss、postoperative hospital stay、degree of decline in GFR after surgery,subgroup analysis based on tumor stage : patients with clinical T2 renal tumors undergoing partial nephrectomy have significantly more intraoperative blood loss than patients under going radical nephrectomy(MD 101.89,95%CI rang 85.1 to 118.68,P <0.00001).All subgroup analyses showed that the degree of decline in GFR after surgery was significantly lower in patients with partial nephrectomy than in patients with radical nephrectomy.A study that can not be combined after grouping was based on the results of the study for general description analysis.Conclusion:For the treatment of clinical T1 b and T2 renal tumor,partial nephrectomy is a surgical procedure that can be chosen,it can better protect the renal function of patients,also play a good role in the control of oncology.