Surgical management of localised renal cell carcinoma

Nabi G, Cleves A, Shelley M

Published Online:

May 12, 2010

Renal cell carcinoma (kidney cancer) is the third most common urological cancer; most commonly detected on abdominal scans or presents with blood in urine, abdominal lump and or pain. Surgical removal remains the only curative option in the localised disease as this tumour is resistant to chemotherapy and radiotherapy. There have been significant improvements in the surgical technology in the recent years, in particular, the introduction of laparoscopic (key hole surgery) and other minimally invasive techniques such as radiofrequency ablation and cryotherapy. The aim of this review was to find out the status of evidence for the use of various surgical treatment options in the management of renal cell carcinoma. Very few good quality studies were found that could be included in this review. There were no randomised controlled trials which compared the results of open surgery to laparoscopic approaches, radiofrequency ablation or cryotherapy. The small studies comparing different laparoscopic approaches (from in front - transperitoneal, or from back - retroperitoneal) found no benefits or disadvantages between the two approaches.

Abstract (click to read)

Background:

Surgical excision remains the core to the management of localised renal cancer and several studies have evaluated the safety and clinical effectiveness of laparoscopic surgery and other recently introduced interventions for the localised disease.

Objectives:

To identify and review the evidence from randomised trials comparing different surgical interventions in localised renal cell carcinoma.

Search strategy:

Randomised or quasi randomised trials comparing various surgical interventions in the management of adults with surgically resectable localised renal cancer. RCTs were identified by searching The Cochrane Central Register of Controlled Trials (CENTRAL, Issue 3, 2009), MEDLINE (Silver Platter, from 1966 to August 2009), EMBASE via Ovid (from 1980 to August 2009), and a number of other data bases.

Selection criteria:

Studies were assessed for eligibility and quality, and data from published trials were extracted by two reviewers.

Data collection and analysis:

Two review authors independently assessed trial quality and extracted data.

Main results:

No randomised trials were identified meeting the inclusion criteria reporting on the comparison between open radical nephrectomy with laparoscopic approach or new modalities of treatment such as radiofrequency or cryoablation. Three randomised controlled trials compared the different laparoscopic approaches to nephrectomy (transperitoneal versus retroperitoneal) and found no statistical difference in operative or perioperative outcomes between the two treatment groups. There were several non-randomised and retrospective case series reporting various advantages of laparoscopic renal cancer surgery such as less blood loss, early recovery and shorter hospital stay

Authors' conclusions:

The main source of evidence for the current practice of laparoscopic excision of renal cancer is drawn from case series, small retrospective studies and very few small randomised controlled trials. The results and conclusions of these studies must therefore be interpreted with caution.

This record should be cited as:

Nabi G, Cleves A, Shelley M. Surgical management of localised renal cell carcinoma. Cochrane Database of Systematic Reviews 2010, Issue 3. Art. No.: CD006579. DOI: 10.1002/14651858.CD006579.pub2

Assessed as up to date:

October 14, 2009

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Primary Review Group:

Prostatic Diseases and Urologic Cancers Group

Health topics:

Urology > Cancer > Renal

Cancer > Renal

Cochrane Summaries^beta

Independent high-quality evidence for health care decision making

Surgical management of localised renal cell carcinoma

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