To compare outcomes of minimally invasive radical nephrectomy (MIS-RN) and robotic-assisted partial nephrectomy (RAPN) in clinical T2a renal mass (T2aRM).
Retrospective, multicenter, propensity score-matched (PSM) comparison of RAPN and MIS-RN for T2aRM (T2aN0M0). Cohorts were PSM for age, sex, BMI, ASA Class, clinical tumor size, and RENAL score using 2:1 ratio for RN:PN. Primary outcome was disease-free survival (DFS). Secondary outcomes included overall survival (OS), complication rates, and de novo eGFR<45mL/min/1.73m2. Multivariable (MVA) and Kaplan-Meier analyses (KMA) were conducted.
648 patients (216 RAPN/432 MIS-RN) were matched. No significant differences were noted in intraoperative complications (p=0.478), Clavien≥3 complications (p=0.063) and readmissions (p=0.238). MVA revealed high ASA score (HR 2.7, p=0.044) and sarcomatoid (HR 5.3, p=0.001), but not surgery type (p=0.601) to be associated with all-cause mortality. Increasing RENAL score (HR 1.31, p=0.037), high tumor-grade (HR 2.5, p=0.043), and sarcomatoid (HR 2.8, p=0.02) were associated with recurrence, but not surgery (p=0.555). Increasing age (HR 1.1, p<0.001) and RN (HR 3.9, p<0.001) were predictors for de novo eGFR<45. Comparing RAPN and MIS-RN, KMA revealed no significant differences for 5-year OS (76.3% vs. 88.0%, p=0.221) and 5-year DFS (78.6% vs. 85.3%, p=0.630) for pT2 RCC, and no differences for 3-year OS (p=0.351) and 3-year DFS (p=0.117) for pT3a upstaged RCC. 5-year freedom from de novo eGFR<45 was 91.6% for RAPN vs. 68.9% for MIS-RN (p<0.001).
RAPN demonstrated similar oncologic outcomes and morbidity profile to MIS-RN while conferring functional benefit. RAPN may be considered as a first-line option for T2aRM.
BJU international. 2020 Mar 31 [Epub ahead of print]
Aaron W Bradshaw, Riccardo Autorino, Giuseppe Simone, Bo Yang, Robert G Uzzo, Francesco Porpiglia, Umberto Capitanio, James Porter, Riccardo Bertolo, Andrea Minervini, Clayton Lau, Kenneth Jacobsohn, Akbar Ashrafi, Daniel Eun, Alexander Mottrie, Wesley M White, Luigi Schips, Benjamin J Challacombe, Ottavio De Cobelli, Carmen M Mir, Alessandro Veccia, Alessandro Larcher, Alexander Kutikov, Monish Aron, Prokar Dasgupta, Francesco Montorsi, Inderbir S Gill, Chandru P Sundaram, Jihad Kaouk, Ithaar H Derweesh
Department of Urology, UC San Diego School of Medicine, La Jolla, USA., Division of Urology, VCU Health System, Richmond, USA., Department of Urology, IRCCS-"Regina Elena" National Cancer Institute, Rome, Italy., Department of Urology, Changhai Hospital, Shanghai, China., Division of Urologic Oncology, Fox Chase Cancer Center, Philadelphia, USA., Department of Urology, University of Turin-San Luigi Gonzaga Hospital, Turin, Italy., Unit of Urology, Division of Experimental Oncology, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy., Swedish Urology Group, Seattle, USA., Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, USA., Department of Urology, Careggi Hospital, University of Florence, Florence, Italy., Division of Urology and Urologic Oncology, City of Hope National Medical Center, Duarte, USA., Department of Urology, Medical College Wisconsin, Milwaukee, USA., Institute of Urology, University of Southern California Keck School of Medicine, Los Angeles, USA., Department of Urology, Lewis Katz School of Medicine at Temple University, Philadelphia, USA., Department of Urology, OLV Hospital, Aalst, Belgium., Department of Urology, University of Tennessee Medical Center, Knoxville, USA., Department of Urology, SS Annunziata Hospital, "G.D'Annunzio" University of Chieti, Chieti, Italy., Urology Centre, NHS Foundation Trust, Guy's and St Thomas's, London, UK., Division of Urology, European Institute of Oncology, Milan, Italy., Department of Urology, Fundacion Instituto Valenciano Oncologia, Valencia, Spain., Department of Urology, Indiana University, Indianapolis, USA.