Nephron-sparing surgery for renal cell carcinoma in children and young adults: A systematic review

Adree Khondker; Jethro C C Kwong; Michael E Chua; Jin K Kim; Justin Y H Chan; Michael Zappitelli; Jack Brzezinski; Nicholas G Cost; Mandy Rickard; Armando J Lorenzo

doi:10.1016/j.urolonc.2022.09.015

Nephron-sparing surgery for renal cell carcinoma in children and young adults: A systematic review

Urol Oncol. 2023 Mar;41(3):137-144. doi: 10.1016/j.urolonc.2022.09.015. Epub 2022 Nov 22.

Authors

Affiliations

¹ Division of Urology, The Hospital for Sick Children, Toronto, ON, Canada.
² Division of Urology, Department of Surgery, Temerty Faculty of Medicine, University of Toronto, ON, Canada.
³ Division of Urology, The Hospital for Sick Children, Toronto, ON, Canada; Division of Urology, Department of Surgery, Temerty Faculty of Medicine, University of Toronto, ON, Canada.
⁴ Division of Nephrology, The Hospital for Sick Children, Toronto, ON, Canada.
⁵ Division of Hematology and Oncology, The Hospital for Sick Children, Toronto, ON, Canada.
⁶ Division of Urology, Department of Surgery, Surgical Oncology Program at Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, CO, USA.
⁷ Division of Urology, The Hospital for Sick Children, Toronto, ON, Canada; Division of Urology, Department of Surgery, Temerty Faculty of Medicine, University of Toronto, ON, Canada. Electronic address: armando.lorenzo@sickkids.ca.

PMID: 36428167
DOI: 10.1016/j.urolonc.2022.09.015

Abstract

Objective: To determine the patient characteristics and role of nephron-sparing surgery (NSS) in the treatment of children and young adults with renal cell carcinoma (RCC).

Methods: A systematic search of Embase, MEDLINE, and Scopus databases was conducted in December 2021 according to Cochrane collaboration recommendations. All included manuscripts were assessed for patient characteristics and all reported outcomes for patients undergoing partial nephrectomy (PN), and radical nephrectomy (RN) outcomes were abstracted as a comparison group. Primary outcomes included surgical outcomes, overall survival, kidney outcomes. Outcomes were pooled with weighted mean and ranges. Meta-analysis was not performed given study quality. This systematic review was prospectively registered on PROSPERO (CRD42022300261).

Results: We found a total of 16 studies describing 119 and 559 unique patients undergoing PN and RN, respectively, with a mean age of 12.2 years and mean follow-up of 59.1 months. The mean tumor size for patients undergoing PN was 3.5 cm. Of the 113 patients undergoing PN with available data, 109 were alive at follow-up (98%). No studies reported long-term kidney outcomes, and four studies reported surgical outcomes. All studies had at least moderate risk of bias.

Conclusions: The use of NSS in children and young adults with RCC is feasible in selected patients. However, small sample sizes, confounding, and low study quality limit clinical recommendation on NSS in this population. There are significant opportunities for future research on the use of NSS in RCC, especially with systematic reporting of oncological, kidney, and surgical outcomes.

Keywords: Nephrectomy; Nephron-sparing surgery; Renal cell carcinoma; Translocation-type.

Publication types

Systematic Review
Review

MeSH terms

Carcinoma, Renal Cell* / pathology
Child
Humans
Kidney / pathology
Kidney Neoplasms* / pathology
Nephrectomy / adverse effects
Nephrons / surgery
Retrospective Studies
Treatment Outcome
Young Adult