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

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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Correspondence to Jean-Alexandre Long.

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The authors declare that they have no conflict of interest.

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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.

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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