Abstract：
To evaluate the efficiency and long-term renal function of nephron sparing surgery (NSS) in unilateral WT patients compared with radical nephrectomy (RN). The review was performed following Cochrane Handbook guidelines and Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). We searched five databases (Pubmed, Embase, Scopus, Web of Science and Cochrane) for studies reporting the efficiency and late renal function of NSS and/or RN on February 10, 2023. Comparative studies were evaluated by Risk of Bias in Non-randomized Studies of Interventions (ROBINS-I) and RoB 2.0. Assessed outcomes included survival rate, relapse rate, eGFR, renal dysfunction and hypertension. 26 studies involving 10322 unilateral WT cases underwent RN and 657 unilateral WT cases underwent NSS were enrolled. Overall effect estimates demonstrated that NSS significantly increased eGFR at follow-up (SMD, 0.38; 95% CI 0.05-0.72; p = 0.025) compared to that at diagnosis, and RN did not significantly decrease eGFR at follow-up (SMD, - 0.33; 95% CI - 0.77-0.11; p = 0.142) compared to that at diagnosis. Moreover, no significant difference was found in outcomes of survivability (OR, 1.38; 95% CI 0.82-2.32; p = 0.226), recurrence (OR, 0.62; 95% CI 0.34-1.12; p = 0.114), eGFR at follow-up (SMD, 0.16; 95% CI - 0.36-0.69; p = 0.538), renal dysfunction (OR, 0.36; 95% CI 0.07-1.73; p = 0.200) and hypertension (OR, 0.17; 95% CI 0.03-1.10; p = 0.063). Current evidence suggests that NSS is safe and effective for unilateral WT patients, because it causes better renal function and similar oncological outcomes compared with RN. Future efforts to conduct more high-quality studies and explore sources of heterogeneity is recommended.
摘要：
评价保留肾单位手术(NSS)与根治性肾切除术(RN)对单侧WT患者的疗效及远期肾功能的影响。审查是根据Cochrane手册指南和系统审查和荟萃分析（PRISMA）的首选报告项目进行的。我们搜索了五个数据库(Pubmed，Embase,Scopus,WebofScienceandCochrane）的研究报告了2023年2月10日NSS和/或RN的效率和晚期肾功能。通过非随机干预研究（ROBINS-I）和RoB2.0中的偏倚风险评估比较研究。评估结果包括生存率，复发率,eGFR,肾功能不全和高血压。纳入26项研究，涉及10322例接受RN的单侧WT病例和657例接受NSS的单侧WT病例。总体效果估计表明，NSS在随访时显着增加eGFR(SMD，0.38；95%CI0.05-0.72；p=0.025)与诊断时相比，随访时RN未显著降低eGFR(SMD，-0.33；95%CI-0.77-0.11；p=0.142）与诊断时相比。此外，生存能力(OR，1.38；95%CI0.82-2.32；p=0.226），复发(或，0.62；95%CI0.34-1.12；p=0.114），随访时的eGFR(SMD，0.16；95%CI-0.36-0.69；p=0.538），肾功能不全（OR，0.36；95%CI0.07-1.73；p=0.200）和高血压（OR，0.17；95%CI0.03-1.10；p=0.063）。目前的证据表明，NSS对单侧WT患者是安全有效的，因为与RN相比，它导致更好的肾功能和相似的肿瘤结局。建议未来努力进行更多高质量的研究并探索异质性的来源。
