Propensity score-matched analysis comparing robot-assisted partial nephrectomy and image-guided percutaneous cryoablation for cT1 renal cell carcinoma

Urol Oncol. 2024 Dec;42(12):453.e15-453.e22. doi: 10.1016/j.urolonc.2024.09.012. Epub 2024 Oct 5.

Abstract

Objectives: This study aimed to compare the clinical outcomes of robot-assisted partial nephrectomy (RAPN) and image-guided percutaneous cryoablation (IG-PCA) for clinical T1 renal cell carcinoma.

Materials and methods: We conducted a retrospective analysis of 679 patients with clinical T1 renal cell carcinoma treated with RAPN or IG-PCA between 2012 and 2021. Propensity scores were calculated via logistic analysis to adjust for imbalances in baseline characteristics. We compared oncological and functional outcomes between the 2 treatment groups.

Results: Following the matching process, 108 patients were included in each group. No patient in the RAPN group developed local recurrence. In the IG-PCA group, three patients experienced local tumor progression. The patients underwent salvage thermal ablations by the secondary technique; 2 underwent IG-PCA and 1 underwent microwave ablation, resulting in a local control rate of 100%. The Kaplan-Meier analysis showed no statistically significant differences between the groups in terms of 5-year recurrence-free survival, metastasis-free survival, and overall survival (log-rank test; P = 0.11, P = 0.64, and P = 0.17, respectively). No significant differences were observed in the 2 treatments in major and overall complication rates (P = 0.75 and P = 0.82, respectively). Both groups showed similar rates of less than 10% estimated glomerular filtration rate decline at 12 months post-treatment and 5-year renal function preservation rates (P = 0.88 and P = 0.38, respectively).

Conclusions: IG-PCA demonstrated oncological outcomes comparable to those of RAPN. RAPN addressed the disadvantages of conventional procedures and allowed for safety outcomes comparable to IG-PCA.

Keywords: Carcinoma, Renal Cell; Cryosurgery; Local Recurrence; Nephrectomy; Survival.

Publication types

  • Comparative Study

MeSH terms

  • Aged
  • Carcinoma, Renal Cell* / pathology
  • Carcinoma, Renal Cell* / surgery
  • Cryosurgery* / methods
  • Female
  • Humans
  • Kidney Neoplasms* / pathology
  • Kidney Neoplasms* / surgery
  • Male
  • Middle Aged
  • Neoplasm Staging
  • Nephrectomy* / methods
  • Propensity Score*
  • Retrospective Studies
  • Robotic Surgical Procedures* / methods
  • Surgery, Computer-Assisted / methods
  • Treatment Outcome