Robotic Partial Nephrectomy versus Minimally Invasive Radical Nephrectomy for Clinical T2a Renal Mass: A Propensity Score Matched Comparison from the ROSULA (Robotic Surgery for Large Renal Mass) Collaborative Group.
Publication Title
BJU international
Document Type
Article
Publication Date
3-31-2020
Keywords
Carcinoma; Chronic Kidney Disease; Complications; Disease-Free Survival; Minimally-Invasive Surgery; Overall Survival; Radical Nephrectomy; Renal Cell; Robotic-Assisted Partial Nephrectomy; Stage 2; estimated Glomerular Filtration Rate
Abstract
OBJECTIVE: To compare outcomes of minimally invasive radical nephrectomy (MIS-RN) and robotic-assisted partial nephrectomy (RAPN) in clinical T2a renal mass (T2aRM).
METHODS: Retrospective, multicenter, propensity score-matched (PSM) comparison of RAPN and MIS-RN for T2aRM (T2aN0M0). Cohorts were PSM for age, sex, BMI, ASA Class, clinical tumor size, and RENAL score using 2:1 ratio for RN:PN. Primary outcome was disease-free survival (DFS). Secondary outcomes included overall survival (OS), complication rates, and de novo eGFR<45mL/min/1.73m2. Multivariable (MVA) and Kaplan-Meier analyses (KMA) were conducted.
RESULTS: 648 patients (216 RAPN/432 MIS-RN) were matched. No significant differences were noted in intraoperative complications (p=0.478), Clavien≥3 complications (p=0.063) and readmissions (p=0.238). MVA revealed high ASA score (HR 2.7, p=0.044) and sarcomatoid (HR 5.3, p=0.001), but not surgery type (p=0.601) to be associated with all-cause mortality. Increasing RENAL score (HR 1.31, p=0.037), high tumor-grade (HR 2.5, p=0.043), and sarcomatoid (HR 2.8, p=0.02) were associated with recurrence, but not surgery (p=0.555). Increasing age (HR 1.1, p
CONCLUSIONS: RAPN demonstrated similar oncologic outcomes and morbidity profile to MIS-RN while conferring functional benefit. RAPN may be considered as a first-line option for T2aRM.
Area of Special Interest
Cancer
Area of Special Interest
Kidney & Diabetes
Specialty/Research Institute
Urology
Specialty/Research Institute
Nephrology
Specialty/Research Institute
Oncology
