Evidence map›Paper›PMID 30255245›Full record

SynthesisEuropean radiology2019

Partial nephrectomy versus ablative techniques for small renal masses: a systematic review and network meta-analysis.

Johannes Uhlig, Arne Strauss, Gerta Rücker, Ali Seif Amir Hosseini, Joachim Lotz, Lutz Trojan, Hyun S Kim, Annemarie Uhlig

Abstract readSystematic ReviewNetwork Meta-Analysis
PubMed Publisher
In one paragraph

Synthesis in European radiology, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 43 papers.

0numbers the graph read from it
0cells of the map it votes in
43citing papers in PubMed
7.3field-weighted citation impact, top 2% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

43 citing papers in PubMed, 110 citations in OpenAlex.

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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

8 authors at 4 institutions in 2 countries.

Johannes UhligDepartment of Diagnostic and Interventional Radiology, University Medical Center Goettingen, Goettingen, Germany.
Arne StraussDepartment of Urology, University Medical Center Goettingen, Robert-Koch-Strasse 40, 37075, Goettingen, Germany.
Gerta RückerFaculty of Medicine and Institute of Medical Biometry and Statistics, Medical Center - University of Freiburg, Freiburg, Germany.
Ali Seif Amir HosseiniDepartment of Diagnostic and Interventional Radiology, University Medical Center Goettingen, Goettingen, Germany.
Joachim LotzDepartment of Diagnostic and Interventional Radiology, University Medical Center Goettingen, Goettingen, Germany.
Lutz TrojanDepartment of Urology, University Medical Center Goettingen, Robert-Koch-Strasse 40, 37075, Goettingen, Germany.
Hyun S KimDivision of Interventional Radiology, Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, CT, USA.
Annemarie UhligDepartment of Urology, University Medical Center Goettingen, Robert-Koch-Strasse 40, 37075, Goettingen, Germany. annemarie.uhlig@med.uni-goettingen.de.ORCID http://orcid.org/0000-0001-7305-9271
University of Göttingen · DEYale University · USGerman Centre for Cardiovascular Research · DEUniversity of Freiburg · DE

Funding

Deutsche Gesellschaft für Urologie UhA1/FE-17
6 · The paper itself

Abstract

purposeTo compare partial nephrectomy (PN), radiofrequency ablation (RFA), cryoablation (CRA) and microwave ablation (MWA) regarding oncologic, perioperative and functional outcomes. MATERIAL AND

methodsThe MEDLINE, EMBASE and COCHRANE libraries were searched for studies comparing PN, RFA, CRA or MWA and reporting on any-cause or cancer-specific mortality, local recurrence, complications or renal function. Network meta-analyses were performed.

resultsForty-seven studies with 24,077 patients were included. Patients receiving RFA, CRA or MWA were older and had more comorbidities compared with PN. All-cause mortality was higher for CRA and RFA compared with PN (incidence rate ratio IRR = 2.58, IRR = 2.58, p < 0.001, respectively). No significant differences in cancer-specific mortality were evident. Local recurrence was higher for CRA, RFA and MWA compared with PN (IRR = 4.13, IRR = 1.79, IRR = 2.52, p < 0.05 respectively). A decline in renal function was less pronounced after RFA versus PN, CRA and MWA (mean difference in GFR MD = 6.49; MD = 5.82; MD = 10.89, p < 0.05 respectively).

conclusionHigher overall survival and local control of PN compared with ablative therapies did not translate into significantly better cancer-specific mortality. Most studies carried a high risk of bias by selecting younger and healthier patients for PN, which may drive superior survival and local control. Physicians should be aware of the lack of high-quality evidence and the potential benefits of ablative techniques for certain patients, including a superior complication profile and renal function preservation. KEY POINTS: • Patients selected for ablation of small renal masses are older and have more comorbidities compared with those undergoing partial nephrectomy. • Partial nephrectomy yields lower all-cause mortality, which is probably biased by patient selection and does not translate into prolonged cancer-free survival. • The decline of renal function is smallest after radiofrequency ablation for small renal masses.

Indexed as

Ablation TechniquesHumansKidney NeoplasmsNephrectomyPatient SelectionTreatment OutcomeAblation techniquesKidney neoplasmsMeta-analysisNephrectomy

Identifiers

PMID30255245
OpenAlexW2892452417

What OpenQuestion holds

Textmetadata
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.