title: Systematic review of oncological outcomes following surgical management of localised renal cancer.
abstract: BACKGROUND
  Renal cell carcinoma (RCC) accounts for 2-3% of adult malignancies. There remain uncertainties over the oncological outcomes for the surgical management of localised RCC.
  
  
  OBJECTIVE
  Systematically review relevant literature comparing oncological outcomes of surgical management of localised RCC (T1-2N0M0).
  
  
  METHODS
  Relevant databases including Medline, Embase, and the Cochrane Library were searched up to October 2010, and an updated scoping search was performed up to January 2012. Randomised controlled trials (RCTs) or quasi-RCTs, prospective observational studies with controls, retrospective matched-pair studies, and comparative studies from well-defined registries/databases were included. The main outcomes were overall survival, cancer-specific survival, recurrence, and metastases. The Cochrane risk of bias tool was used to assess RCTs, and an extended version was used to assess nonrandomised studies (NRSs). The quality of evidence was assessed using Grading of Recommendations Assessment, Development, and Evaluation (GRADE).
  
  
  RESULTS
  A total of 4580 abstracts and 389 full-text articles were assessed. Thirty-four studies met the inclusion criteria (6 RCTs and 28 NRSs). Meta-analyses were planned but were deemed inappropriate due to data heterogeneity. There were high risks of bias and low-quality evidence across the evidence base. Open radical nephrectomy and open partial nephrectomy showed similar cancer-specific and overall survival, but when both open and laparoscopic approaches are considered together, the evidence showed improved survival for partial nephrectomy for tumours ≤4cm. The overall evidence suggests either equivalent or better survival with partial nephrectomy. Laparoscopic radical nephrectomy offered equivalent survival to open radical nephrectomy, and all laparoscopic approaches achieved equivalent survival. Open and laparoscopic partial nephrectomy achieved equivalent survival. The issue of ipsilateral adrenalectomy or complete lymph node dissection with radical nephrectomy or partial nephrectomy remains unresolved.
  
  
  CONCLUSIONS
  The evidence base suggests localised RCCs are best managed by nephron-sparing surgery where technically feasible. However, the current evidence base has significant limitations due to studies of low methodological quality marked by high risks of bias.
authors.affiliation: Academic Urology Unit, University of Aberdeen, Aberdeen, UK.
authors.forename: Steven
authors.initials: S
authors.lastname: MacLennan
authors.forename: Mari
authors.initials: M
authors.lastname: Imamura
authors.forename: Marie C
authors.initials: MC
authors.lastname: Lapitan
authors.forename: Muhammad Imran
authors.initials: MI
authors.lastname: Omar
authors.forename: Thomas B L
authors.initials: TB
authors.lastname: Lam
authors.forename: Ana M
authors.initials: AM
authors.lastname: Hilvano-Cabungcal
authors.forename: Pam
authors.initials: P
authors.lastname: Royle
authors.forename: Fiona
authors.initials: F
authors.lastname: Stewart
authors.forename: Graeme
authors.initials: G
authors.lastname: MacLennan
authors.forename: Sara J
authors.initials: SJ
authors.lastname: MacLennan
authors.forename: Steven E
authors.initials: SE
authors.lastname: Canfield
authors.forename: Sam
authors.initials: S
authors.lastname: McClinton
authors.forename: T R Leyshon
authors.initials: TR
authors.lastname: Griffiths
authors.forename: Börje
authors.initials: B
authors.lastname: Ljungberg
authors.forename: James
authors.initials: J
authors.lastname: N'Dow
mesh_terms: D000315:Adrenalectomy / Q000379:methods; D015982:Bias; D002292:Carcinoma, Renal Cell / Q000601:surgery*; D005260:Female; D006801:Humans; D007680:Kidney Neoplasms / Q000601:surgery*; D010535:Laparoscopy / Q000379:methods; D008197:Lymph Node Excision / Q000379:methods; D008297:Male; D009392:Nephrectomy / Q000379:methods; D016032:Randomized Controlled Trials as Topic; D015996:Survival Rate; D016896:Treatment Outcome