Comparison of Outcomes Between Partial and Radical Laparoscopic Nephrectomy for Localized Renal Tumors Larger Than Four Centimeters: A Systematic Review and Meta-Analysis.

IF 2.1 Q3 ONCOLOGY World Journal of Oncology Pub Date : 2024-08-01 Epub Date: 2024-07-05 DOI:10.14740/wjon1866
Bao Nan Dong, Jie Song, Wen Li Yang, Hui Zhan, Ting Luan, Jian Song Wang
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Abstract

Background: Earlier studies have juxtaposed different laparoscopic methods for treating renal tumors; however, extensive evidence with a particular focus on large kidney tumors remains lacking. The objective of this meta-analysis was to assess the perioperative outcomes, kidney performance, and cancer-related results of laparoscopic partial nephrectomy (LPN) versus laparoscopic radical nephrectomy (LRN) for treating extensive, localized, non-metastatic kidney tumors (cT1b-cT2N0M0).

Methods: We systematically searched multiple databases from database inception until December 2023 for relevant studies. Selected data were analyzed with the Cochrane Collaboration's Review Manager 5.4 software using a random-effects model. Outcomes were expressed as odds ratios and weighted mean differences with 95% confidence intervals, considering a P value of < 0.05 as significant.

Results: Data from nine studies encompassing 1,303 patients (529 LPN, 774 LRN) revealed that LPN was associated with lengthier surgeries and increased blood loss compared to LRN. While LPN exhibited higher postoperative complication rates, the disparity did not reach statistical significance. LPN led to improved postoperative renal function, manifesting as a reduced estimated glomerular filtration rate (eGFR) decline and fewer incidents of new chronic kidney disease cases. Both groups demonstrated comparable tumor recurrence and overall mortality rates, but LPN exhibited significantly lower cancer-specific mortality rates.

Conclusions: LPN, despite longer operative times and greater intraoperative blood loss, was found to be superior to LRN in preserving postoperative renal function. Oncologically, LPN and LRN have comparable overall mortality rates, but LPN showed a significant advantage in terms of lower cancer-specific mortality rates.

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局部和根治性腹腔镜肾切除术治疗大于四厘米的局部肾肿瘤的疗效比较:系统回顾与元分析》。
背景:早期的研究将不同的腹腔镜方法并列用于治疗肾脏肿瘤;然而,特别是针对大型肾脏肿瘤的大量证据仍然缺乏。本荟萃分析的目的是评估腹腔镜肾部分切除术(LPN)与腹腔镜根治性肾切除术(LRN)治疗广泛、局部、非转移性肾肿瘤(cT1b-cT2N0M0)的围术期结果、肾脏表现和癌症相关结果:我们系统地检索了从数据库开始到 2023 年 12 月的多个数据库中的相关研究。采用随机效应模型,使用 Cochrane Collaboration 的 Review Manager 5.4 软件对所选数据进行分析。研究结果以几率比和加权平均差表示,95% 为置信区间,以 P 值小于 0.05 为显著:九项研究共涉及 1303 名患者(529 名 LPN,774 名 LRN),研究数据显示,与 LRN 相比,LPN 的手术时间更长,失血量更多。虽然 LPN 的术后并发症发生率较高,但其差异未达到统计学意义。LPN 术后肾功能有所改善,表现为估计肾小球滤过率(eGFR)下降和新发慢性肾病病例减少。两组的肿瘤复发率和总死亡率相当,但LPN的癌症特异性死亡率明显较低:结论:尽管LPN手术时间更长、术中失血更多,但在保护术后肾功能方面却优于LRN。从肿瘤学角度看,LPN 和 LRN 的总死亡率相当,但 LPN 在降低癌症特异性死亡率方面具有显著优势。
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来源期刊
CiteScore
6.10
自引率
15.40%
发文量
37
期刊介绍: World Journal of Oncology, bimonthly, publishes original contributions describing basic research and clinical investigation of cancer, on the cellular, molecular, prevention, diagnosis, therapy and prognosis aspects. The submissions can be basic research or clinical investigation oriented. This journal welcomes those submissions focused on the clinical trials of new treatment modalities for cancer, and those submissions focused on molecular or cellular research of the oncology pathogenesis. Case reports submitted for consideration of publication should explore either a novel genomic event/description or a new safety signal from an oncolytic agent. The areas of interested manuscripts are these disciplines: tumor immunology and immunotherapy; cancer molecular pharmacology and chemotherapy; drug sensitivity and resistance; cancer epidemiology; clinical trials; cancer pathology; radiobiology and radiation oncology; solid tumor oncology; hematological malignancies; surgical oncology; pediatric oncology; molecular oncology and cancer genes; gene therapy; cancer endocrinology; cancer metastasis; prevention and diagnosis of cancer; other cancer related subjects. The types of manuscripts accepted are original article, review, editorial, short communication, case report, letter to the editor, book review.
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