Partial versus radical nephrectomy for renal cell carcinoma: A systematic review and meta-analysis.

Abstract

e16551 Background: Renal cell carcinoma (RCC) is a common urological challenge, for which radical nephrectomy (RN) has served as the traditional surgical treatment for a long time. However, partial nephrectomy (PN) has gained acceptance as a nephron-sparing alternative and has the benefits of preserving renal function and reducing long-term metabolic morbidity. Although PN is increasingly favoured for localized tumors, its oncological safety relative to RN remains a subject of ongoing debate. This systematic review and Meta-analysis aims to compare the clinical efficacy and safety of PN versus RN in patients with RCC. Methods: Electronic databases were searched for studies comparing RN and PN for RCC from inception till January 2026. Inclusion criteria included randomized and non-randomized controlled trials, retrospective and observational studies/cohorts. Meta-analysis was conducted using R software (V.4.5.2) with the "META" package. Binary outcomes were pooled using MH Random Effects model with Odds Ratio (OR) and continuous outcomes using mean differences (MD) with the inverse variance random-effects model. Heterogeneity was assessed with τ² and I² statistics, sensitivity analysis was performed using a leave-one-out approach, and publication bias was evaluated using funnel plots and Egger’s regression test. Results: This systematic review and meta-analysis included 45 studies with a population size of 79,417 (PN = 28,192; RN = 51,225). PN was associated with a statistically significant decrease in all-cause mortality (OR = 0.63; 95% CI: [0.41, 0.96]; p = < 0.0001), and cancer-specific mortality (OR = 0.45; 95% CI: [0.25, 0.81]; p = < 0.0001), and demonstrated improved overall survival (OR = 1.46; 95% CI: [1.14, 1.88]; p = < 0.0001). However, RN was associated with improvement in postoperative complications (OR = 1.29; 95% CI: [1.08, 1.54]; p = < 0.0001), incidence of urinary fistula (OR = 7.02; 95% CI: [3.20, 15.39]; p = 0.538) and reduced operation time (MD = 14.15; 95% CI: [4.50, 23.81]; p = < 0.0001). Outcomes including eGFR, blood loss, length of stay, and cardiovascular complications, were comparable between the two surgical approaches. Conclusions: PN demonstrates superior overall and cancer-specific survival compared to RN, significantly reducing mortality risk for RCC patients. However, these benefits come at the cost of increased operative times and a higher risk of postoperative complications, specifically urinary fistulas. Surgeons should balance the long-term survival benefits of PN against the reduced perioperative risks associated with RN.