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WCE 2018: A Propensity-Score Matched Comparison of Perioperative Outcomes of Robotic Partial Nephrectomy for cT1a 2 cm Renal Masses

Paris, France (UroToday.com) About 15-25% of all renal tumors <4 cm (T1a) treated surgically are found to be benign on final pathology. This raises the question whether all T1a renal tumors have to be actively treated (by partial nephrectomy, radical nephrectomy, or thermal ablation). Indeed, the American Urological Association (AUA) Guideline on Renal Mass and Localized Renal Cancer recommends active surveillance as an option for initial management, especially when the tumor is smaller than 2 cm.

A group from the Glickman Urological and Kidney Institute at Cleveland Clinic sought to compare the outcomes of patients undergoing robotic partial nephrectomy at a single center for T1a masses <2 cm vs. >2 cm. A total of 524 patients were compared using a 1:1 propensity score matching. The two groups were comparable with regard to baseline parameters (age, gender, BMI, R.E.N.A.L. nephrometry score, comorbidities, creatinine, and eGFR) except for tumor size. Patients with smaller tumors were found to have statistically significant favorable operative outcomes; shorter total operative time (18 minutes shorter) as well as ischemia time (14 vs. 22 minutes), less bleeding, and lower rate of transfusions. In addition, in patients with smaller tumors a higher percentage of parenchymal preservation was attained (90% vs. 84%), and a better eGFR was maintained from POD1 to 1 year. Most importantly, smaller tumors were found to be benign in 75% of cases vs. 86% for larger tumors.

Preoperative renal biopsy for T1a tumors is still controversial and indeed, the majority of these tumors are not biopsied prior to surgery. Of note, the patients in this cohort did not have a histopathological diagnosis prior to their surgery. When asked about the role of renal biopsy, Dr. Bertolo replied that in light of these results (14-25% of tumors turned out to be benign), more patients with smaller tumors will be offered renal biopsy in the future. 

Presented by: Riccardo Bertolo, MD, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA
Authors: Riccardo Bertolo, Juan Garisto, Julien Dagenais, Daniel Sagalovich, Jose Agudelo, Robert Stein, Khaled Fareed, Tianming Gao, Amr Fergany, and Jihad Kaouk

Affiliation: Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA

Written by: Dr. Shlomi Tapiero, (Department of Urology, University of California-Irvine) medical writer for UroToday at the 36th World Congress of Endourology (WCE) and SWL - September 20-23, 2018 Paris, France