The impact of open versus minimally invasive surgery on recurrence pattern in the management of localized renal cell carcinoma (RCC) remains uncertain. We thus aimed to determine the impact of surgical approach on survival and recurrence pattern.
This is a multi-institutional, matched cohort study on patients with pT1-3aN0M0 RCC from the RECUR database. After propensity score matching between open and minimally invasive surgery, disease-free (DFS) survival and risk of first recurrence according to recurrence site, namely local recurrence, abdominal/retroperitoneal, thoracic/mediastinal or uncommon site metastases were investigated with Cox regression analysis. Overall (OS) and Cancer Specific Survival (CSS) were also assessed.
After matching, 1,019 patients who underwent open and 1,019 who underwent minimally invasive surgery were included (of which 70 robot-assisted). At 5.2 years of median follow-up, 130 patients in open and 125 in minimally invasive group experienced disease progression. A higher risk of local recurrence (HR 2.06; 95% CI 1.18-3.58, P-value = 0.01) and uncommon site metastases (HR 1.09; 95% CI 1.01-1.16; P-value = .04) was found for minimally invasive surgery relative to open surgery, while no difference was found in terms of DFS (HR 0.83; 95% CI 0.64-1.06; P-value = .14). No differences were found in terms of OS and CSS. Main limitation is the retrospective nature of the study.
The risk for local recurrence and uncommon site metastases was higher for minimally invasive surgery compared to open surgery, although no differences were found for OS, CSS, and DFS.
Urologic oncology. 2022 Sep 17 [Epub ahead of print]
Giuseppe Fallara, Alessandro Larcher, Saeed Dabestani, Nicola Fossati, Petrus Järvinen, Harry Nisen, Eirikur Gudmundsson, Thomas B Lam, Lorenzo Marconi, Sergio Fernandéz-Pello, Richard P Meijer, Alessandro Volpe, Christian Beisland, Tobias Klatte, Grant D Stewart, Karim Bensalah, Börje Ljungberg, Roberto Bertini, Francesco Montorsi, Axel Bex, Umberto Capitanio
Division of Experimental Oncology/Unit of Urology; URI; IRCCS Ospedale San Raffaele, Milan, Italy; University Vita-Salute San Raffaele, Milan, Italy., Department of Translational Medicine, Division of Urological Cancers, Kristianstad Central Hospital, Lund University, Lund, Sweden., Abdominal Center, Urology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland., Department of Urology, Landspitali University Hospital, Reykjavik, Iceland., Academic Urology Unit, University of Aberdeen, Aberdeen, UK., Department of Urology, Coimbra University Hospital, Coimbra, Portugal., Department of Urology, Cabueñes University Hospital, Gijón, Spain., Department of Oncological Urology, University Medical Centre Utrecht, Utrecht, The Netherlands., Department of Urology, University of Eastern Piedmont, Maggiore della Carità Hospital, Novara, Italy., Department of Urology, Haukeland University Hospital, Norway and Department of Clinical Medicine, University of Bergen, Bergen, Norway., Department of Surgery, University of Cambridge, Cambridge, UK; Department of Urology, The Royal Bournemouth Hospital, University Hospitals Dorset NHS Foundation Trust, Bournemouth, UK., Department of Surgery, University of Cambridge, Cambridge, UK., Department of Urology, University of Rennes, Rennes, France., Department of Surgical and Perioperative Sciences, Umeå University, Umeå, Sweden., Centre for Kidney Cancer, Royal Free London NHS Foundation Trust, UCL Division of Surgical and Interventional Science, London, UK; Department of Urology, Netherlands Cancer Institute, Amsterdam, The Netherlands., Division of Experimental Oncology/Unit of Urology; URI; IRCCS Ospedale San Raffaele, Milan, Italy; University Vita-Salute San Raffaele, Milan, Italy. Electronic address: .
PubMed http://www.ncbi.nlm.nih.gov/pubmed/36127233