A systematic review and meta-analysis of laparoscopic partial nephrectomy versus laparoscopic focal therapy for small renal masses.

Background: Laparoscopic partial nephrectomy (LPN) and laparoscopic focal therapy (LFT) have emerged as minimally invasive alternatives for managing small renal masses. Despite their increasing clinical adoption, comparative evidence regarding their clinical profiles remains limited. This systematic review and meta-analysis comprehensively evaluates perioperative outcomes, renal function preservation, and oncological efficacy between these 2 interventions for small renal mass treatment.

Methods: A systematic literature search was conducted across Embase, Cochrane Library, and PubMed to identify comparative studies evaluating LPN versus LFT including radiofrequency ablation, microwave ablation, cryoablation, irreversible electroporation, and stereotactic body radiation therapy. Statistical synthesis was performed using random-effects models to calculate pooled mean differences (MD) and odds ratios with corresponding 95% confidence intervals (CIs) through Review Manager, version 5.2 (The Cochrane Collaboration, Oxford, United Kingdom) Stata v.12.0 (Stata Corp LLC, College Station, TX).

Results: The meta-analysis incorporated 10 studies encompassing 1247 participants. Compared with LPN, LFT demonstrated significantly shorter operating time (MD -51.76, 95% CI -88.22 to -15.30; I2 = 97%, P = .005) and reduced estimated blood loss (MD -107.92, 95% CI -139.35 to -76.48; I2 = 15%, P < .00001). LFT interventions also showed advantages in postoperative recovery, with shorter length of stay (MD -1.61; CI -2.44 to -0.78; I2 = 91%, P = .0001) and better preservation of renal function as measured by estimated glomerular filtration rate (MD -8.21; CI -10.77 to -.64; I2 = 0%, P < .00001). However, LFTs were associated with a 3.42-fold increased risk of local tumor recurrence (odds ratios 3.42; CI 1.25-9.33; I2 = 0%, P = .02). No significant between-group differences were observed in overall complication rates (P > .05).

Conclusion: LPN demonstrates superior oncological control with reduced local recurrence risks relative to LFT. Conversely, LFT exhibit significant advantages in nephron preservation, minimized intraoperative hemorrhage, and accelerated length of stay. In the contemporary minimally invasive treatment paradigm, clinical decision-making requires careful consideration of tumor biology, renal functional reserve, and individualized risk-benefit profiles to optimize therapeutic strategies.