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Partial nephrectomy versus ablative therapy for the treatment of renal tumors in an imperative setting

World Journal of Urology volume 35, pages 649–656 (2017)Cite this article

Abstract

Purpose

To compare partial nephrectomy (PN) and percutaneous ablative therapy (AT) for renal tumor in imperative indication of nephron-sparing technique (NST).

Materials and methods

Between 2000 and 2015, 284 consecutive patients with a kidney tumor in an imperative indication of NST were retrospectively included in a multicenter study. PN [open (n = 146), laparoscopic (n = 9), or robotic approach (n = 17)] and AT [radiofrequency ablation (n = 104) or cryoablation (n = 8)] were performed for solitary kidney (n = 146), bilateral tumor (n = 78), or chronic kidney disease (CKD) (n = 60).

Results

Patients in the PN group had larger tumors and a higher RENAL score. There were no differences between the two groups with respect to age, reasons for imperative indication, and preoperative eGFR. Patients in the AT group had a higher ASA and CCI. PN had worse outcomes than AT in terms of transfusion rate, length of stay, and complication rate. Local radiological recurrence-free survival was better for PN, but metastatic recurrence was similar. Percentage of eGFR decrease was similar in the two groups. Temporary or permanent dialysis was not significantly different. On multivariate analysis, PN and AT had a similar eGFR change when adjusted for tumor complexity, reason of imperative indication and CCI.

Conclusion

In imperative indication of nephron-sparing treatment for a kidney tumor, either PN or AT can be proposed. PN offers the ability to manage larger and more complex tumors while providing a better local control and a similar renal function loss.

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Author’s contribution

Jean-Alexandre Long was involved in project development, data management, data analysis, and manuscript writing; Jean-Christophe Bernhard and Pierre Bigot were involved in project development and data management; Cecilia Lanchon was involved in manuscript writing. Philippe Paparel, Nathalie Rioux-Leclercq, François-Xavier Nouhaud, Pierre Gimel, and Laurence Albiges were involved in data management; Thomas Bodin, Romain Boissier, Arnaud Méjean, Alexandra Masson-Lecomte, Nicolas Grenier, Francois Cornelis, Yohann Grassano, Vincent Comat, Quentin Come LE CLERC, Jérome Rigaud, Laurent Salomon, Jean-Luc Descotes, Christian Sengel, Morgan Roupret, Gregory Verhoest, Idir Ouzaid, and Valentin Arnoux were involved in data collection; and Karim Bensalah was involved in project development, data management, data analysis, and manuscript writing.

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Authors and Affiliations

  1. Urology Department, Grenoble University Hospital, 38043, Grenoble, France

    Jean-Alexandre Long, Cecilia Lanchon & Jean-Luc Descotes

  2. TIMC-IMAG Laboratory, UMR CNRS 5525, Grenoble, France

    Jean-Alexandre Long

  3. Urology Department, Bordeaux University Hospital, Bordeaux, France

    Jean-Christophe Bernhard, Yohann Grassano & Vincent Comat

  4. Urology Department, Angers University Hospital, Angers, France

    Pierre Bigot

  5. Urology Department, Lyon-Sud University Hospital, Pierre-Bénite, France

    Philippe Paparel

  6. Pathology Department, Rennes University Hospital, Rennes, France

    Nathalie Rioux-Leclercq

  7. Oncology Department, Gustave Roussy Institute, Paris, France

    Laurence Albiges

  8. Prado-Louvain Urology Center, Marseille, France

    Thomas Bodin

  9. Urology Department, Rouen University Hospital, Rouen, France

    François-Xavier Nouhaud

  10. Urology Department, La Conception University Hospital, Marseille, France

    Romain Boissier

  11. Urology Department, Medipole, Cabestany, France

    Pierre Gimel

  12. Urology Department, Georges Pompidou University Hospital, Paris, France

    Arnaud Méjean

  13. Urology Department, Mondor University Hospital, Creteil, France

    Alexandra Masson-Lecomte & Laurent Salomon

  14. Radiology Department, Bordeaux University Hospital, Pessac, France

    Nicolas Grenier & Francois Cornelis

  15. Urology Department, Nantes University Hospital, Nantes, France

    Quentin Come Le Clerc & Jérome Rigaud

  16. Radiology Department, Grenoble University Hospital, La Tronche, France

    Christian Sengel

  17. Urology Department, La Pitie-Salpetriere University Hospital, Paris, France

    Morgan Roupret

  18. Urology Department, Rennes University Hospital, Rennes, France

    Gregory Verhoest & Karim Bensalah

  19. Urology Department, Bichat University Hospital, Paris, France

    Idir Ouzaid

  20. Urology Department, Annecy-Genevois Hospital, Metz-Tessy, France

    Valentin Arnoux

Authors
  1. Jean-Alexandre Long
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  2. Jean-Christophe Bernhard
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  3. Pierre Bigot
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  11. Pierre Gimel
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  13. Alexandra Masson-Lecomte
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  14. Nicolas Grenier
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  15. Francois Cornelis
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  16. Yohann Grassano
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  17. Vincent Comat
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  18. Quentin Come Le Clerc
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  19. Jérome Rigaud
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  20. Laurent Salomon
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  21. Jean-Luc Descotes
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  22. Christian Sengel
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  23. Morgan Roupret
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  24. Gregory Verhoest
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  25. Idir Ouzaid
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  26. Valentin Arnoux
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  27. Karim Bensalah
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for the French association of Urology Cancerology Comitee (CCAFU)

Corresponding author

Correspondence to Jean-Alexandre Long.

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The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.

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Long, JA., Bernhard, JC., Bigot, P. et al. Partial nephrectomy versus ablative therapy for the treatment of renal tumors in an imperative setting. World J Urol 35, 649–656 (2017). https://doi.org/10.1007/s00345-016-1913-4

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  • DOI: https://doi.org/10.1007/s00345-016-1913-4

Keywords

  • Renal cancer
  • Partial nephrectomy
  • Radiofrequency
  • Cryoablation
  • Imperative indication