Tumor enucleation versus conventional partial nephrectomy for localized renal tumors: a systematic review and meta-analysis of functional, perioperative, and margin outcomes
Source: PubMed Central Open Access, NCBI / U.S. National Library of Medicine
Background Tumor enucleation (TE) may preserve more renal parenchyma than conventional partial nephrectomy (PN), but its functional and safety benefits remain debated. This study updated the evidence comparing TE and PN for localized renal tumors, mainly clinical T1 disease. Methods PubMed, Embase, Web of Science, the Cochrane Library, Scopus, and CNKI were searched to May 2026. Comparative studies of TE versus PN in adults with localized renal tumors were included. Key outcomes were postoperative eGFR, absolute ΔeGFR, positive surgical margin (PSM), and major complications. Random-effects models were used. Results Seventeen studies with 5,249 patients were included. TE was associated with higher postoperative eGFR (MD = 5.64 mL/min/1.73 m², 95% CI 3.64–7.63, P <0.00001; I² = 12%) and smaller absolute ΔeGFR (MD = −2.12 mL/min/1.73 m², 95% CI −3.85 to −0.39, P = 0.02; I² = 14%). TE did not increase PSM risk (OR = 0.73, 95% CI 0.46–1.13, P = 0.16; I² = 25%) and was associated with fewer major complications (OR = 0.48, 95% CI 0.32–0.71, P = 0.0003; I² = 0%). TE also showed shorter WIT, shorter operative time, and lower EBL, but these perioperative outcomes had high heterogeneity. Long-term oncological outcomes could not be pooled. Conclusion TE may offer better renal functional preservation and fewer major complications than conventional PN in selected patients with localized renal tumors, without increasing PSM risk. However, evidence for absolute ΔeGFR was limited, perioperati
Abstract
Background Tumor enucleation (TE) may preserve more renal parenchyma than conventional partial nephrectomy (PN), but its functional and safety benefits remain debated. This study updated the evidence comparing TE and PN for localized renal tumors, mainly clinical T1 disease. Methods PubMed, Embase, Web of Science, the Cochrane Library, Scopus, and CNKI were searched to May 2026. Comparative studies of TE versus PN in adults with localized renal tumors were included. Key outcomes were postoperative eGFR, absolute ΔeGFR, positive surgical margin (PSM), and major complications. Random-effects models were used. Results Seventeen studies with 5,249 patients were included. TE was associated with higher postoperative eGFR (MD = 5.64 mL/min/1.73 m², 95% CI 3.64–7.63, P <0.00001; I² = 12%) and smaller absolute ΔeGFR (MD = −2.12 mL/min/1.73 m², 95% CI −3.85 to −0.39, P = 0.02; I² = 14%). TE did not increase PSM risk (OR = 0.73, 95% CI 0.46–1.13, P = 0.16; I² = 25%) and was associated with fewer major complications (OR = 0.48, 95% CI 0.32–0.71, P = 0.0003; I² = 0%). TE also showed shorter WIT, shorter operative time, and lower EBL, but these perioperative outcomes had high heterogeneity. Long-term oncological outcomes could not be pooled. Conclusion TE may offer better renal functional preservation and fewer major complications than conventional PN in selected patients with localized renal tumors, without increasing PSM risk. However, evidence for absolute ΔeGFR was limited, perioperative outcomes were heterogeneous, and long-term oncological equivalence remains uncertain. Systematic review registration , identifier PROSPERO CRD420261361330.