Partial versus radical nephrectomy for pT3a renal cell carcinoma: a systematic review and meta-analysis

The surgical management of pathologic T3a (pT3a) renal cell carcinoma (RCC) remains contentious due to the lack of high-level evidence guiding the choice between partial nephrectomy (PN) and radical nephrectomy (RN). This systematic review and meta-analysis aims to evaluate whether PN represents a safe and effective alternative to RN. A comprehensive search of PubMed, Web of Science, and Scopus was conducted through July 2025. The study included comparative trials of adult pT3a RCC patients undergoing PN or RN, focusing on oncological, perioperative, and functional outcomes. Sixteen retrospective studies involving 34,304 patients (5878 PN; 28426 RN) were analyzed. There were no statistically significant differences between PN and RN regarding estimated blood loss, operative time, hospital stay, or major postoperative complications (Clavien-Dindo > 2). PN was associated with significantly better preservation of renal function (9.96; I2 0%; p < 0.01), higher rate of positive surgical margins (0.82; I2 49.2%; p < 0.01), lower tumor size (-2.6; I2 99.4%; p < 0.01). PN is a safe and feasible alternative for pT3a RCC cases, providing superior functional preservation without compromising perioperative safety or oncological control.