Comparative efficacy of nephron-sparing surgery versus total nephrectomy on operative and prognostic results in pT2 kidney tumors: a meta-analysis.

Objective: To compare the impact of partial nephrectomy (PN) versus radical nephrectomy (RN) on perioperative and prognostic results in patients with pT2 Kidney tumors. Methodology: A comprehensive search of key databases was conducted up to December 2025, excluding conference abstracts and meta-analyses. Outcomes were assessed using odds ratios (OR), weighted mean differences (WMD), and standardized mean differences (SMD). Statistical analyses were performed using Review Manager software. The study protocol was registered on PROSPERO (CRD420251272895). Results: A pooled analysis of seven studies involving 2,715 patients showed that partial nephrectomy (PN) could reduce the probability of tumor recurrence (odds ratio [OR]: 0.57; 95% confidence interval [CI]: 0.39–0.84; P = 0.05). No significant statistical differences were observed in the four perioperative indicators—operative time, intraoperative estimated blood loss, length of hospital stay, and postoperative complications—between PN and radical nephrectomy (RN). In terms of prognosis, no significant difference was found between PN and RN in 2‑year or 5‑year cancer‑specific survival rates. Except for tumor size, baseline characteristics were comparable; the tumor size in the PN group was significantly smaller, which may be attributable to surgical decisions made out of concern for patient safety. Conclusion: PN may be prioritized for T2 renal tumors due to its advantages in reducing blood loss and hospitalization. However, high heterogeneity in perioperative outcomes warrants cautious interpretation. Future studies should control for tumor size disparities and compare long-term survival and subcategories of surgical approaches.