Dataset Information

Safety and Efficacy of Thermal Ablation for Small Renal Masses in Solitary Kidney: Evidence from Meta-Analysis of Comparative Studies.

ABSTRACT: To evaluate comparative renal functional preservation, perioperative and oncologic outcomes, and complications of thermal ablation (TA) versus partial nephrectomy (PN) in management of Small renal masses (SRMs) in solitary kidney.Medline, Embase, Web of Science and the Cochrane Library were systematically searched. A meta-analysis for comparative studies comparing TA with PN was performed. According to predefined inclusion criteria, seven datasets were identified from 8 observational studies including a total of 628 patients. Cumulated data showed the changes of creatinine (p=0.02) and estimated glomerular filtration rate (eGFR) (p<0.0001) in TA arm were significantly less than these in PN arm. Significantly less new-set chronic kidney disease (CKD) was observed in TA group (p=0.04). In terms of postoperative dialysis rate, the difference favoring TA was also noted, though there is no statistical significance (p=0.09). With regard to perioperative outcomes, our data demonstrated that patients who underwent TA had significantly shorter operation time (p=0.002), less blood loss (p<0.0001), shorter length of stay (p<0.00001), and less transfusion rate (p=0.01) than those underwent PN. In addition, patients underwent TA suffered less intra- and postoperative complications (p=0.007, p<0.00001; respectively). With regard to oncologic outcomes, disease-free survival (DFS) (p<0.00001) and cancer-specific survival (CSS) (p=0.01) in the PN arm were significantly better than these of the TA arm. But, TA yielded a comparable overall survival to PN (p=0.40). Sensitivity analyses led to very similar results with overall results, and confirmed its stability.Our analysis indicates that PN have advantage in controlling cancer recurrence. However, TA is associated with significantly better renal functional preservation and perioperative outcomes, and less complications without increasing overall death. Our data suggest that indication for TA may be extended to select younger, healthier patients who desire a much less invasive therapeutic option.

SUBMITTER: Yang Q

PROVIDER: S-EPMC4484808 | biostudies-literature | 2015

REPOSITORIES: biostudies-literature

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Safety and Efficacy of Thermal Ablation for Small Renal Masses in Solitary Kidney: Evidence from Meta-Analysis of Comparative Studies.

Yang Quancheng Q Meng Fanzheng F Li Kai K Wang Tong T Nie Qingyuan Q Che Zi Z Liu Min M Sun Yan Y Zhao Lin L

PloS one 20150629 6

<h4>Objective</h4>To evaluate comparative renal functional preservation, perioperative and oncologic outcomes, and complications of thermal ablation (TA) versus partial nephrectomy (PN) in management of Small renal masses (SRMs) in solitary kidney.<h4>Methods and findings</h4>Medline, Embase, Web of Science and the Cochrane Library were systematically searched. A meta-analysis for comparative studies comparing TA with PN was performed. According to predefined inclusion criteria, seven datasets w ...[more]

PMID: 26121336

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Project description:IntroductionAcute renal colic is one of the most common urological emergencies. While previous randomized controlled trials (RCTs) and pairwise meta-analyses only looked at the efficacy of 1 or 2 analgesics. It is not fully understood that the comprehensive ranking of the effectiveness and safeness of analgesics from these published articles. Therefore, this network meta-analysis (NMA) aims to compare and rank the different analgesics for treatment of acute renal colic.Methods and analysisWe will perform a systematic literature search in PubMed, EMBASE, CINAHL, Web of Science, and Cochrane Library to identify RCTs of different analgesics for acute renal colic. RCTs assessing active analgesics intervention against active comparator or placebo controls for acute renal colic will be included. We will also screen the reference lists of included studies, previous reviews and meta-analyses to identify other relevant trials. The primary outcomes will be pain variance at 30 minutes, need rescue medicine, complete pain relief or at least 50% pain relief at 30 minutes, and pain relapse within 24 hours. We will also assess secondary outcomes for safeness (side effects: dizziness, vomit, allergic, hypotension, cardiac toxicity, and drug dependence). The risk of bias of included RCTs will be assessed by using the Cochrane Collaboration's tool, and the quality of evidence will be assessed by using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) instrument. We will perform pairwise meta-analysis and Bayesian NMA to compare the effectiveness and safeness of different analgesic interventions.ResultsThis NMA will compare and rank the different analgesics for treatment of acute renal colic.ConclusionThis is the first systematic review to use the NMA to comprehensively compare and rank analgesics for relieving pain of acute renal colic in adults based on most important factors deciding the choice of initial analgesia, and the results can provide implications for clinical practice and further research.

Dataset Information

Safety and Efficacy of Thermal Ablation for Small Renal Masses in Solitary Kidney: Evidence from Meta-Analysis of Comparative Studies.

Publications

Safety and Efficacy of Thermal Ablation for Small Renal Masses in Solitary Kidney: Evidence from Meta-Analysis of Comparative Studies.

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