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

Reasoning:

• To educate patient about management of renal masses and localized renal cancer since there are multiple treatment methods
• Patient does not know much about renal masses
• He wants to know the optimal treatment option to allow him to return to work the fastest

Purpose:

• The purpose of this systematic review/meta-analysis is to summarize and compare the effectiveness of various management options for localized renal masses, including active surveillance, thermal ablation, radial nephrectomy, or partial nephrectomy

Methods:

• Three databases were utilized: Medline, Embase, and Cochrane to screen through 20,829 initial articles to include 107 final studies
• Outcomes studied included oncologic outcomes, renal functional outcomes and complications, cancer specific survival, metastasis-free survival, local recurrence-free survival, overall survival, quality of life, and perioperative outcome and harms

Key Points:

• Overall survival and oncologic outcomes are similar between the various management options
  • Most common predictors of cancer specific survival are age, larger tumor size, and higher tumor grade
  • Most common predictors of overall survival are age and comorbidities
• Cancer specific survival was high among all modalities
• 5 year survival is ~95% for stage T1a tumors
• Larger tumors are more likely to be malignant
  • Should consider radical nephrectomy for larger stage T1b or T2 tumors
• Overall survival is highly dependent on comorbidities
  • Partial nephrectomy had higher overall survival rates when compared to thermal ablation or active surveillance due to better general heath
  • Patients undergoing nonsurgical treatments had worst overall survival compared to those undergoing radical or partial nephrectomy
• Current evidence does not support any one treatment modality as superior
  • Thermal ablation requires multiple treatments to achieve similar local control as compared to radical or partial nephrectomy but has less blood loss and shorter length of stay in hospital

Conclusion:

• Important to consider patient and tumor characteristics, comorbidities, quality of life, and perioperative outcomes and harms

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