title: Partial nephrectomy vs. radical nephrectomy for renal tumors: A meta-analysis of renal function and cardiovascular outcomes.
abstract: The widespread use of partial nephrectomy (PN) has led to the preservation of functional renal parenchyma. However, the benefits of PN on renal function and cardiovascular outcomes remain controversial. Thus, a meta-analysis was performed to reconcile the conflicting results.
  
  
  
  PubMed, Embase, and the Cochrane Library were searched from inception to August 2015, and databases with all relevant comparative studies were included. The Mantel-Haenszel method with random-effects models was used to determine the pooled hazard ratios (HRs) for each outcome.
  
  
  
  In total, 26 studies were pooled for new-onset chronic kidney disease, and 6 studies were pooled for cardiovascular outcomes. According to the pooled estimates, PN correlated with a 73% risk reduction of new-onset chronic kidney disease in all included patients (HR = 0.27, P<0.0001) and a 65% risk reduction in patients with tumors>4cm (HR = 0.35, P<0.0001) compared with radical nephrectomy. There were no significant differences between groups regarding postsurgery cardiovascular events (HR = 0.86, P = 0.238) and cardiovascular death (HR = 0.79, P = 0.196). Despite inherent selection biases, the pooled estimates were robust in sensitivity and subgroup analyses.
  
  
  
  Our findings suggest that PN lowers the postoperative risk of new-onset chronic kidney disease. Nevertheless, the protection of renal function by PN did not reduce the risk of cardiovascular outcomes. However, this result remains controversial, and additional large-scale evaluations are warranted.
authors: Minimally Invasive Urology Center, Provincial Hospital Affiliated to Shandong University, Jinan, Shandong, China.
authors: Zheng
authors: Z
authors: Wang
authors: Minimally Invasive Urology Center, Provincial Hospital Affiliated to Shandong University, Jinan, Shandong, China; Urology Center, Maternal and Child Health Care Center of Shandong Province, Jinan, Shandong, China.
authors: Ganggang
authors: G
authors: Wang
authors: Minimally Invasive Urology Center, Provincial Hospital Affiliated to Shandong University, Jinan, Shandong, China.
authors: Qinghua
authors: Q
authors: Xia
authors: Shandong University School of Medicine, Shandong University, Jinan, Shandong, China.
authors: Zhenhua
authors: Z
authors: Shang
authors: Minimally Invasive Urology Center, Provincial Hospital Affiliated to Shandong University, Jinan, Shandong, China.
authors: Xiao
authors: X
authors: Yu
authors: Minimally Invasive Urology Center, Provincial Hospital Affiliated to Shandong University, Jinan, Shandong, China.
authors: Muwen
authors: M
authors: Wang
authors: Minimally Invasive Urology Center, Provincial Hospital Affiliated to Shandong University, Jinan, Shandong, China. Electronic address: jxbsdu@gmail.com.
authors: Xunbo
authors: X
authors: Jin
mesh_terms: D002292:Carcinoma, Renal Cell / Q000503:physiopathology / Q000601:surgery*; D016022:Case-Control Studies; D015331:Cohort Studies; D005500:Follow-Up Studies; D006331:Heart Diseases / Q000453:epidemiology / Q000517:prevention & control; D006801:Humans; D007668:Kidney / Q000503:physiopathology*; D007680:Kidney Neoplasms / Q000503:physiopathology / Q000601:surgery*; D009392:Nephrectomy / Q000379:methods*; D051436:Renal Insufficiency, Chronic / Q000453:epidemiology / Q000517:prevention & control; D012189:Retrospective Studies; D040242:Risk Reduction Behavior; D015983:Selection Bias; D016896:Treatment Outcome
keywords: Cardiovascular outcomes; Meta-analysis; Partial nephrectomy; Radical nephrectomy; Renal function