Kidney-sparing Treatments for Local Recurrence in Renal Cell Tumours After Partial Nephrectomy or Focal Therapy: A Systematic Review

Background and objective: Kidney-sparing treatments are salvage options for renal cell carcinoma (RCC) after local recurrence. However, there is no level 1 evidence in the literature examining the efficacy of focal therapies (FTs) and partial nephrectomy (PN) in a head-to-head, randomised comparison. Methods: A systematic search (PROSPERO CRD420251033642) was performed. The present analysis adhered to the Preferred Reporting Items for Systematic Reviews and Meta-analyses statement. Key findings and limitations: Overall, 30 studies involving 873 patients were included in the final analysis. Patients with RCC were treated primarily with FTs (n = 376, 43%) and PN (n = 462, 53%). Of FTs, cryoablation was received by 198 (57%) RCC patients. The rates of recurrence for FTs ranged from 4% to 20%, while those for PN ranged from 3% to 19%. The intraoperative complication rates ranged from 2% to 6% for FTs and from 3% to 9% for PN. The postoperative complications rates ranged from 2% to 40% for FTs and from 8% to 40% for PN, while the major postoperative complications rates, defined as Clavien-Dindo ≥3, ranged from 2% to 9% for FTs and from 1% to 18% for PN. The rates of overall survival ranged from 82% to 100% for FTs, and from 96% to 100% for PNs. Limitations included the bias in patients’ selection and the absence of time-to-event data. Conclusions and clinical implications: PN achieved acceptable overall survival, recurrence, and complication profiles, demonstrating its feasibility in a salvage setting. Patient selection is mandatory to identify those best candidates for PN and FT, thereby prioritising oncological outcomes.