Collaborative Review of Risk Benefit Trade-offs Between Partial and Radical Nephrectomy in the Management of Anatomically Complex Renal Masses
Collaborative Review of Risk Benefit Trade-offs Between Partial and Radical Nephrectomy in the Management of Anatomically Complex Renal Masses
复制标题
DOI：
10.1016/j.eururo.2016.11.038
复制
发表时间：
2017-07-01
期刊：
影响因子：
23.4
通讯作者：
Kutikov, Alexander
中科院分区：
文献类型：
--
作者：
Kim, Simon P.;Campbell, Steven C.;Kutikov, Alexander
背景资料：虽然部分肾切除术（PN）是许多小肾脏肿块的推荐治疗方法，但解剖结构复杂的肿瘤需要清楚地了解PN和根治性肾切除术（RN）的潜在风险和益处。目的：严格审查PN与RN的比较有效性证据;描述这种治疗决策中涉及的关键权衡;并强调当前文献中的差距。证据获取：协作的医学文献进行了批判性审查carried.Evidence synthesis：患者接受PN的解剖结构复杂或大的质量可能会暴露于围手术期和潜在的肿瘤风险，可以避免，如果RN进行，而接受RN的患者可能会放弃长期的肾脏保护的好处。对于解剖结构复杂或肾肿块较大的患者，关于PN或RN最佳治疗的决策非常微妙，必须平衡每种方法的风险和受益。目前，关于相对有效性的高质量证据很少。回顾性比较困扰的选择偏见，而现有的前瞻性随机试验，虽然不完美，表明保留肾单位手术可能不会使所有patients.Conclusions：对于解剖复杂的肿瘤，PN保留肾实质，但可能会暴露患者更高的围手术期风险比RN。必须更好地客观评价每种手术入路的风险和受益，以确定最适合复杂PN的患者。一个前瞻性的随机试验是必要的，将有助于指导病人咨询。患者概要：复杂肾脏肿块的治疗决策需要就部分肾切除术和根治性肾切除术之间的风险权衡进行共同决策。(C)2016年欧洲泌尿外科协会。Elsevier B. V.出版，保留所有权利。
Background: While partial nephrectomy (PN) is the recommended treatment for many small renal masses, anatomically complex tumors necessitate a clear understanding of the potential risks and benefits of PN and radical nephrectomy (RN).Objective: To critically review the comparative effectiveness evidence of PN versus RN; to describe key trade-offs involved in this treatment decision; and to highlight gaps in the current literature.Evidence acquisition: A collaborative critical review of the medical literature was conducted.Evidence synthesis: Patients who undergo PN for an anatomically complex or large mass may be exposed to perioperative and potential oncologic risks that could be avoided if RN were performed, while patients who undergo RN may forgo long-term benefits of renal preservation. Decision-making regarding the optimal treatment with PN or RN among patients with anatomically complex or large renal mass is highly nuanced and must balance the risks and benefits of each approach. Currently, high-quality evidence on comparative effectiveness is sparse. Retrospective comparisons are plagued by selection biases, while the one existing prospective randomized trial, albeit imperfect, suggests that nephron-sparing surgery may not benefit all patients.Conclusions: For anatomically complex tumors, PN preserves renal parenchyma but may expose patients to higher perioperative risks than RN. The risks and benefits of each surgical approach must be better objectified for identification of patients most suitable for complex PN. A prospective randomized trial is warranted and would help in directing patient counseling. Patient summary: Treatment decisions for complex renal masses require shared decision-making regarding the risk trade-offs between partial and radical nephrectomy. (C) 2016 European Association of Urology. Published by Elsevier B.V. All rights reserved.