Comparison Of Efficacy And Safety Between Partial Nephrectomy And Radical Nephrectomy In The Treatment Of Clinical T1b And T2 Renal Cell Carcinoma: A Meta-analysis

Objective: To compare the efficacy and safety of partial nephrectomy(PN)and radical nephrectomy(RN)in the treatment of clinical T1 b and T2 renal cell carcinoma(RCC).Methods: A literature review was performed from January 1993 to December 2019 in both Chinese and English databases,such as Cochrane Library,Pub Med,Ovid,CNKI,EMBASE,Wanfang Data and VIP.A series of published articles comparing PN and RN in the treatment of T1 b and T2 RCC were selected.Develop inclusion and exclusion criteria,the literature retrieved were screened according to the standard and the quality evaluation was rated for each study.Valid data related to the included literature were extracted and analyzed using the Revman 5.3 software provided by Cochrane.Results: 11 studies were included,including 4052 patients,834 were in the PN group and 3218 were in the RN group.The data of 11 included studies were analyzed.There was no difference in operation time [MD=13.60,95% CI(-10.25,37.44),P=0.26],intraoperative complications [OR=1.18,95% CI(0.65,2.13),P=0.59],estimated blood loss [MD=104.03,95% CI(-3.84,211.90),P=0.06] and the incidence of postoperative complications between the two groups [OR=1.07,95% CI(0.79,1.46),P=0.66].Postoperative CKD in PN group was less than that in RN group [OR=0.33,95% CI(0.24,0.47),P<0.00001].Postoperative glomerular filtration rate of PN group was higher than that of RN group [MD=14.70,95% CI(12.10,17.30),P<0.00001].The PN group had less 5-years tumor recurrence than the RN group [OR=0.48,95% CI(0.30,0.78),P=0.003].The 5-years cancer-specific mortality of PN group was lower than that of RN group [OR=0.57,95% CI(0.38,0.86),P=0.007].The 5-years all-cause mortality was lower in the PN group than in the RN group [OR=0.60,95%ci(0.42,0.85),P=0.004].Conclusions: PN is safe and effective for the treatment of clinical T1 b and T2 RCC.PN can better protect the renal function,and PN is lower than RN in terms of tumor recurrence,cancer-specific mortality and all-cause mortality.When conditions permit and techniques are feasible,priority should be given to PN treatment of T1 b and T2 RCC.