Perioperative and Survival Outcomes of Patients Treated With Robot-Assisted Partial Nephrectomy and Percutaneous Microwave Ablation for Small Renal Masses: A Single Center Experience

Gianpaolo Lucignani; Elisa De Lorenzis; Anna Maria Ierardi; Carlo Silvani; Andrea Marmiroli; Marco Nizzardo; Giancarlo Albo; Gianpaolo Carrafiello; Emanuele Montanari; Luca Boeri

doi:10.1016/j.clgc.2023.11.004

Perioperative and Survival Outcomes of Patients Treated With Robot-Assisted Partial Nephrectomy and Percutaneous Microwave Ablation for Small Renal Masses: A Single Center Experience

Clin Genitourin Cancer. 2024 Apr;22(2):237-243. doi: 10.1016/j.clgc.2023.11.004. Epub 2023 Nov 7.

Affiliations

¹ Department of Urology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.
² Department of Urology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy; Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy.
³ Department of Radiology, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, University of Milan, Milan, Italy.
⁴ Department of Urology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy. Electronic address: dr.lucaboeri@gmail.com.

PMID: 38065718
DOI: 10.1016/j.clgc.2023.11.004

Abstract

Background: Robot assisted partial nephrectomy (RAPN) and microwave ablation (MWA) are 2 of the most advanced techniques for the management of localized small renal masses.

Purpose: To compare the perioperative, functional and oncological results of RAPN and MWA.

Materials and methods: Data from 171 consecutive patients undergoing either RAPN or MWA for a localized small renal mass at a single academic center was retrospectively collected. Baseline features included patients' demographics and masses' characteristics. Procedures were compared in terms of perioperative outcomes and renal function variation Progression of a persistent lesion or local recurrence after a complete treatment defined local tumor progression. Descriptive statistics and survival analysis tested the association between predictors and local tumor progression.

Results: Of all, 109 and 62 patients underwent RAPN and MWA. Patients in the MWA group were older (P = .002) had higher Charlson Comorbidity Index (CCI) (P < .001) and higher frequency of preoperative chronic kidney disease (P < .001). MWA led to a shorter postoperative hospitalization time (P < .001) and lower incidence of medical complications (6.5% vs. 22.9%, P = .02) than RAPN. GFR decline was similar between groups both at discharge (P = .39) and at the time of last follow up (P = 1.00). A lower rate of secondary interventions (11.7% vs. 2.8%, P = .037) and a better disease-free survival (83.2% vs. 96.5%, P = .027) were reported after RAPN. Conversely, cancer specific and overall survival were comparable (P > .05). At univariate regression analysis, MWA was associated with local tumor progression (HR 3.46, P = .040).

Conclusion: MWA displayed a lower perioperative impact, while functional outcomes were similar after each intervention. RAPN resulted superior in terms of tumor eradication, but no difference was noted regarding cancer specific survival. Thus, MWA represents a valid alternative in frail patients, though less radical than RAPN.

Keywords: Complications; Microwave ablation; Renal tumor; Robotic partial nephrectomy; Survival.

MeSH terms

Humans
Kidney Neoplasms* / pathology
Microwaves / therapeutic use
Nephrectomy / methods
Retrospective Studies
Robotic Surgical Procedures* / methods
Robotics*
Treatment Outcome