| Abstract [eng] |
This thesis incorporates 11 articles published since 2020 focusing on laparoscopic partial nephrectomy, robot assisted partial nephrectomy and cryoablation for T1a and T1b renal cell carcinomas. This time frame has been chosen to ensure that incorporated studies were not extensively assessed and incorporated into systematic reviews and meta-analyses and therefore represent the most recent developments regarding this topic. A comprehensive literature retrieval of the PubMed database was conducted by using a Boolean string to identify relevant literature. Initially 111 articles were identified and further processed. For primary sources of this thesis, systematic reviews and meta-analyses, case series, narrative reviews and trial protocols were excluded to ensure that no double presentation of studies occur, results are available, and the results are representative of a wider population, rather than only depicting a series of cases. Using a variation of the PICO framework the initial 111 articles were further screened excluding articles which did not match the outlined. Methodological excerption of relevant information and thorough incorporation into excel sheets was performed. Relevant findings have been displayed in tables providing a well-structured overview over every single study as well as granting the possibility to directly compare the studies in a narrative approach. Most findings have also been described in written text while some findings a restricted to the tables for better readability. Thorough analyzing of the exerted data lead to the discussion of the weaknesses and strengths of the methods as well as of the written thesis itself. Strengths are the well- structured and reproducible literature retrieval, thorough presentation of materials and methods as well as implementation of comparing findings with published literature. Important is the identification of variations of included patients for each treatment modality highlighting the concept of individualized treatments based on factors such as age or renal function. Sadly, this thesis also identified the gap the representation of the female sex in medical studies. Interestingly, paradox findings have been identified within the studies as compared to already published systematic reviews and meta-analyses. Weaknesses were the amount of available literature and the limitations in direct comparison due to variations in values and lack of data presented by the studies. This thesis concludes that the ongoing development of new treatment modalities warrants ongoing research so that physicians have the possibility to offer patients individualized treatment options suiting every patient. Underrepresentation of patient groups such as the elderly, females, and patients with comorbidities should be considered an appeal for future research, including more previously underrepresented patients. |
