Simple tumor enucleation may not decrease oncologic outcomes for T1 renal cell carcinoma: A systematic review and meta-analysis

Objective: To evaluate the clinical efficacy and safety of simple tumor enucleation (TE) for clinical T1 renal cell carcinoma. Materials and methods: A systematic search of PubMed, EMBASE, and Cochrane Central Register of Controlled Trials databases was performed to identify all trials that compared TE and traditional partial nephrectomy (PN) for patients with clinical T1 renal cell carcinoma. Results: A total of 7 studies involving 3,218 patients were identified and included in this meta-analysis. Compared with the PN group, the TE group had significantly shorter estimated operation times (mean difference [MD] = -21.93; 95% CI: -31.07 to -12.78; P < 0.001), shorter warm ischemia times (MD = -1.96; 95% CI: -3.80 to -0.13; P = 0.04), less blood loss (MD = -36.63; 95% CI: -57.49 to -15.77; P = 0.0006), and lower surgical complication rates (odds ratio [OR] = 0.66; 95% CI: 0.47-0.92; P = 0.02). Furthermore, there was no significant difference between the 2 groups in hospital stay duration (MD = -0.46; 95% CI: -0.93 to 0.02; P = 0.06), changes in estimated glomerular filtration rate (MD = 3.35; 95% CI: -2.78 to 9.48; P = 0.28), positive surgical margin rates (OR = 0.34; 95% CI: 0.10-1.14; P = 0.08), and local recurrence rates (OR = 0.71; 95% CI: 0.24-2.06; P = 0.52). Conclusion: Compared to traditional PN, TE is an effective and safe treatment for T1 renal tumors, and TE appears to have acceptable early oncology outcomes. Owing to the limited number of clinical trials and the predominantly retrospective data on this subject, there is a need for properly designed studies to confirm our findings. (C) 2017 Elsevier Inc. All rights reserved.