Management of Renal Masses and Localized Renal Cancer: Systematic Review and Meta-Analysis

No AccessJournal of UrologyReview Article1 Oct 2016Management of Renal Masses and Localized Renal Cancer: Systematic Review and Meta-Analysis Phillip M. Pierorazio, Michael H. Johnson, Hiten D. Patel, Stephen M. Sozio, Ritu Sharma, Emmanuel Iyoha, Eric B. Bass, and Mohamad E. Allaf Phillip M. PierorazioPhillip M. Pierorazio James Buchanan Brady Urological Institute, Johns Hopkins Medical Institutions, Baltimore, Maryland , Michael H. JohnsonMichael H. Johnson James Buchanan Brady Urological Institute, Johns Hopkins Medical Institutions, Baltimore, Maryland , Hiten D. PatelHiten D. Patel James Buchanan Brady Urological Institute, Johns Hopkins Medical Institutions, Baltimore, Maryland , Stephen M. SozioStephen M. Sozio Department of Medicine, Johns Hopkins Medical Institutions, Baltimore, Maryland Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins Medical Institutions, Baltimore, Maryland , Ritu SharmaRitu Sharma Johns Hopkins Evidence-Based Practice Center, Johns Hopkins School of Public Health, Baltimore, Maryland , Emmanuel IyohaEmmanuel Iyoha Johns Hopkins Evidence-Based Practice Center, Johns Hopkins School of Public Health, Baltimore, Maryland , Eric B. BassEric B. Bass Johns Hopkins Evidence-Based Practice Center, Johns Hopkins School of Public Health, Baltimore, Maryland , and Mohamad E. AllafMohamad E. Allaf James Buchanan Brady Urological Institute, Johns Hopkins Medical Institutions, Baltimore, Maryland View All Author Informationhttps://doi.org/10.1016/j.juro.2016.04.081AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract Purpose: Several options exist for management of clinically localized renal masses suspicious for cancer, including active surveillance, thermal ablation and radical or partial nephrectomy. We summarize evidence on effectiveness and comparative effectiveness of these treatment approaches for patients with a renal mass suspicious for localized renal cell carcinoma. Materials and Methods: We searched MEDLINE®, Embase® and the Cochrane Central Register of Controlled Trials from January 1, 1997 through May 1, 2015. Paired investigators independently screened articles to identify controlled studies of management options or cohort studies of active surveillance, abstracted data sequentially and assessed risk of bias independently. Strength of evidence was graded by comparisons. Results: The search identified 107 studies (majority T1, no active surveillance or thermal ablation stratified outcomes of T2 tumors). Cancer specific survival was excellent among all management strategies (median 5-year survival 95%). Local recurrence-free survival was inferior for thermal ablation with 1 treatment but reached equivalence to other modalities after multiple treatments. Overall survival rates were similar among management strategies and varied with age and comorbidity. End-stage renal disease rates were low for all strategies (0.4% to 2.8%). Radical nephrectomy was associated with the largest decrease in estimated glomerular filtration rate and highest incidence of chronic kidney disease. Thermal ablation offered the most favorable perioperative outcomes. Partial nephrectomy showed the highest rates of urological complications but overall rates of minor/major complications were similar among interventions. Strength of evidence was moderate, low and insufficient for 11, 22 and 30 domains, respectively. Conclusions: Comparative studies demonstrated similar cancer specific survival across management strategies, with some differences in renal functional outcomes, perioperative outcomes and postoperative harms that should be considered when choosing a management strategy. References 1 : Incidence of benign pathologic findings at partial nephrectomy for solitary renal mass presumed to be renal cell carcinoma on preoperative imaging. Urology2006; 68: 737. Google Scholar 2 : Metastatic renal cell carcinoma risk according to tumor size. J Urol2009; 182: 41. 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Volume 196Issue 4October 2016Page: 989-999Supplementary Materials Advertisement Copyright & Permissions© 2016 by American Urological Association Education and Research, Inc.Keywordssurgical procedures, operativedisease managementcomparative effectiveness researchcarcinoma, renal cellkidney neoplasmsAcknowledgmentsAllen Zhang and Emily Little assisted with data abstraction. Dr. Tim Carey supplied commentary and performed revisions. Dr. Steven Campbell and Dr. Aysegul Gozu provided feedback and insight.MetricsAuthor Information Phillip M. Pierorazio James Buchanan Brady Urological Institute, Johns Hopkins Medical Institutions, Baltimore, Maryland More articles by this author Michael H. Johnson James Buchanan Brady Urological Institute, Johns Hopkins Medical Institutions, Baltimore, Maryland More articles by this author Hiten D. Patel James Buchanan Brady Urological Institute, Johns Hopkins Medical Institutions, Baltimore, Maryland More articles by this author Stephen M. Sozio Department of Medicine, Johns Hopkins Medical Institutions, Baltimore, Maryland Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins Medical Institutions, Baltimore, Maryland More articles by this author Ritu Sharma Johns Hopkins Evidence-Based Practice Center, Johns Hopkins School of Public Health, Baltimore, Maryland More articles by this author Emmanuel Iyoha Johns Hopkins Evidence-Based Practice Center, Johns Hopkins School of Public Health, Baltimore, Maryland More articles by this author Eric B. Bass Johns Hopkins Evidence-Based Practice Center, Johns Hopkins School of Public Health, Baltimore, Maryland More articles by this author Mohamad E. Allaf James Buchanan Brady Urological Institute, Johns Hopkins Medical Institutions, Baltimore, Maryland More articles by this author Expand All Advertisement PDF downloadLoading ...