title: Comparative effectiveness for survival and renal function of partial and radical nephrectomy for localized renal tumors: a systematic review and meta-analysis.
abstract: OBJECTIVE
  The relative effectiveness of partial vs radical nephrectomy remains unclear in light of the recent phase 3 European Organization for the Research and Treatment of Cancer trial. We performed a systematic review and meta-analysis of partial vs radical nephrectomy for localized renal tumors, considering all cause and cancer specific mortality, and severe chronic kidney disease.
  
  
  METHODS
  Cochrane Central Register of Controlled Trials, MEDLINE®, EMBASE®, Scopus and Web of Science® were searched for sporadic renal tumors that were surgically treated with partial or radical nephrectomy. Generic inverse variance with fixed effects models were used to determine the pooled HR for each outcome.
  
  
  RESULTS
  Data from 21, 21 and 9 studies were pooled for all cause and cancer specific mortality, and severe chronic kidney disease, respectively. Overall 31,729 (77%) and 9,281 patients (23%) underwent radical and partial nephrectomy, respectively. According to pooled estimates partial nephrectomy correlated with a 19% risk reduction in all cause mortality (HR 0.81, p < 0.0001), a 29% risk reduction in cancer specific mortality (HR 0.71, p = 0.0002) and a 61% risk reduction in severe chronic kidney disease (HR 0.39, p < 0.0001). However, the pooled estimate of cancer specific mortality for partial nephrectomy was limited by the lack of robustness in consistent findings on sensitivity and subgroup analyses.
  
  
  CONCLUSIONS
  Our findings suggest that partial nephrectomy confers a survival advantage and a lower risk of severe chronic kidney disease after surgery for localized renal tumors. However, the results should be evaluated in the context of the low quality of the existing evidence and the significant heterogeneity across studies. Future research should use higher quality evidence to clearly demonstrate that partial nephrectomy confers superior survival and renal function.
authors.affiliation: Department of Urology, Mayo Clinic, Rochester, Minnesota 55905, USA.
authors.forename: Simon P
authors.initials: SP
authors.lastname: Kim
authors.forename: R Houston
authors.initials: RH
authors.lastname: Thompson
authors.forename: Stephen A
authors.initials: SA
authors.lastname: Boorjian
authors.forename: Christopher J
authors.initials: CJ
authors.lastname: Weight
authors.forename: Leona C
authors.initials: LC
authors.lastname: Han
authors.forename: M Hassan
authors.initials: MH
authors.lastname: Murad
authors.forename: Nathan D
authors.initials: ND
authors.lastname: Shippee
authors.forename: Patricia J
authors.initials: PJ
authors.lastname: Erwin
authors.forename: Brian A
authors.initials: BA
authors.lastname: Costello
authors.forename: George K
authors.initials: GK
authors.lastname: Chow
authors.forename: Bradley C
authors.initials: BC
authors.lastname: Leibovich
mesh_terms: D002423:Cause of Death / Q000639:trends; D005060:Europe / Q000453:epidemiology; D005919:Glomerular Filtration Rate / Q000502:physiology*; D006801:Humans; D007677:Kidney Function Tests; D007680:Kidney Neoplasms / Q000401:mortality / Q000503:physiopathology / Q000601:surgery; D009392:Nephrectomy / Q000379:methods*; D020127:Recovery of Function / Q000502:physiology*; D015996:Survival Rate / Q000639:trends; D016896:Treatment Outcome