Renal cell carcinoma (RCC) in solitary kidney (SK) represents a challenging scenario. We sought to compare outcomes of robot-assisted partial nephrectomy (RAPN) versus percutaneous thermal ablation (PTA) in SK patients with renal tumors cT1.
We performed a multicenter retrospective analysis of SK patients treated for RCC. The PTA group included cryoablation or radiofrequency ablation. We collected baseline characteristics, intraoperative, pathological, and post-operative data. We applied an arbitrary composite "trifecta" to assess surgical, functional, and oncological outcomes, only for malignant histology. RFS analysis was performed using the Kaplan-Meier method. Multivariable regression analysis was performed to determine independent predictors of "trifecta" achievement.
We included 198 SK patients (RAPN, n = 50; PTA n = 119). Mean clinical tumor size was not significantly different while R.E.N.A.L. score was higher for RAPN (p < 0.001). No differences in intra and major post-procedural complications. Recurrence rate was higher in PTA group but not statistically significant (p < 0.328). No difference in metastasis rate was found (p = 0.435). RFS was 96.1% in RAPN and 86.8% in PTA cohort (p = 0.003) while no difference in PFS was detected (p = 0.1). Trifecta was achieved in 72.5% of RAPN vs 77.3% of PTA (p = 0.481). Multivariable analysis has not detected predictors for Trifecta achievement.
PTA offers good outcomes in the management of SK patients with RCC. Compared with RAPN, it might carry a higher risk of recurrence; on the other hand, re-treatment is possible. Overall, PTA can be safely offered to treat SK patients presenting RCC. In general, it should be preferred in more frail patients to minimize the risk of complications.
European journal of surgical oncology : the journal of the European Society of Surgical Oncology and the British Association of Surgical Oncology. 2022 Oct 04 [Epub ahead of print]
Savio Domenico Pandolfo, Davide Loizzo, Alp T Beksac, Ithaar Derweesh, Antonio Celia, Lorenzo Bianchi, Jeffrey Elbich, Giovanni Costa, Umberto Carbonara, Giuseppe Lucarelli, Clara Cerrato, Margaret Meagher, Pasquale Ditonno, Lance J Hampton, Giuseppe Basile, Fernando J Kim, Riccardo Schiavina, Umberto Capitanio, Jihad Kaouk, Riccardo Autorino
Division of Urology & Massey Cancer Center, VCU Health, Richmond, VA, USA; Department of Neurosciences, Reproductive Sciences and Odontostomatology, Urology Unit, University of Naples "Federico II", Napoli, Italy. Electronic address: ., Division of Urology & Massey Cancer Center, VCU Health, Richmond, VA, USA; Department of Emergency and Organ Transplantation-Urology, Andrology and Kidney Transplantation Unit, University of Bari, Bari, Italy., Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA., Department of Urology, University of California San Diego School of Medicine, La Jolla, CA, USA., Department of Urology, San Bassano Hospital, Bassano Del Grappa, Italy., Division of Urology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy., Department of Radiology, Vascular Interventional Radiology, VCU Health, Richmond, VA, USA., Division of Urology & Massey Cancer Center, VCU Health, Richmond, VA, USA., Department of Emergency and Organ Transplantation-Urology, Andrology and Kidney Transplantation Unit, University of Bari, Bari, Italy., Department of Urology, San Raffaele Scientific Institute, Milan, Division of Experimental Oncology/Unit of Urology, URI, IRCCS San Raffaele Hospital, Milan, Italy., Division of Urology, Denver Health, Denver, CO, USA.