Data comparing percutaneous ablation (PCA) and surgical resection (SR) for an isolated local recurrence (LR) following partial nephrectomy (PN) for renal cell carcinoma (RCC) are lacking.
To examine the outcomes between PCA and SR for an isolated LR following PN for RCC.
Patients who underwent PN for RCC and developed an LR between 2013 and 2019 were included. An LR was defined as the appearance of a mass in contact with the resection bed or the development of a tumor in the same region of the homolateral kidney as the original site.
PCA or SR.
To achieve balance in baseline characteristics, we used inverse probability of treatment weighting (IPTW) based on propensity to receive treatment. Oncological outcomes, complications, and renal function were evaluated between groups using logistic, linear, and Cox proportional hazard regression models.
A total of 81 patients with an isolated LR were included (PCA: 42; SR: 39). The median follow-up was 23 mo. After adjustment, excellent balance was achieved for the majority of propensity score variables. In IPTW analysis, PCA was associated with a lower risk of postoperative complications (odds ratio=0.22; p=0.006) and a smaller change in eGFR (beta=-16.18; p=0.001). There were no significant differences in the risk of disease recurrence (hazard ratio [HR]=0.72; p=0.61), new LR (HR=1.51; p=0.59), and distant metastasis (HR=0.19; p=0.09). Limitations include the sample size and unmeasured confounding factors.
Our results suggest that PCA provides comparable oncological outcomes to repeat surgery with fewer complications and better renal function preservation for the management of an LR after PN.
This report shows that percutaneous ablation can be used for treating a local recurrence of renal cell carcinoma after partial nephrectomy, without significantly compromising cancer control.
European urology focus. 2021 Feb 20 [Epub ahead of print]
Marie Brassier, Zine-Eddine Khene, Jean-Christophe Bernhard, Van Thi Dang, Idir Ouzaid, François Xavier Nouhaud, Jonathan Olivier, Cosmina Nedelcu, Nicolas Grenier, Luc Beuzit, Nicolas Doumerc, Karim Bensalah, Pierre Bigot, Members of the French Committee of Urologic Oncology
Department of Urology, Angers University Hospital, Angers, France. Electronic address: ., Department of Urology, Rennes University Hospital, Rennes, France., Department of Urology, Bordeaux University Hospital, Bordeaux, France., Department of Urology and Renal Transplantation, Toulouse University Hospital, Toulouse, France., Department of Urology, Bichat Hospital, APHP, Paris Diderot University, Paris, France., Department of Urology, Rouen University Hospital, Rouen, France., Department of Urology, Lille University Hospital, Lille, France., Department of Radiology, Angers University Hospital, Angers, France., Department of Radiology, Bordeaux University Hospital, Bordeaux, France., Department of Radiology, Rennes University Hospital, Rennes, France., Department of Urology, Angers University Hospital, Angers, France.