학술논문
Minimally invasive nephron-sparing treatments for T1 renal cell cancer in patients over 75 years: a comparison of outcomes after robot-assisted partial nephrectomy and percutaneous ablation.
Document Type
Article
Author
Lehrer, Raphaël; Cornelis, Francois; Bernhard, Jean-Christophe; Bigot, Pierre; Champy, Cécile; Bruyère, Franck; Rouprêt, Morgan; Doumerc, Nicolas; Bensalah, Charles-Karim; Olivier, Jonathan; Audenet, François; Tricard, Thibault; Parier, Bastien; Durand, Xavier; Durand, Matthieu; Charles, Thomas; Branger, Nicolas; Surlemont, Louis; Xylinas, Evanguelos; Beauval, Jean-Baptiste
Source
Subject
*RENAL cancer
*SURGICAL robots
*NEPHRECTOMY
*CANCER patients
*KIDNEY surgery
*KIDNEY transplantation
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Language
ISSN
0938-7994
Abstract
Purpose: To compare the oncological and perioperative outcomes of robot-assisted partial nephrectomy (RPN) and percutaneous thermal ablation (PTA) for treatment of T1 renal cell cancer (RCC) in patients older than 75 years. Materials and methods: Retrospective national multicenter study included all patients older than 75 years treated for a T1 RCC by RPN or PTA between January 2010 and January 2021. Patients' characteristics, tumor data, and perioperative and oncological outcomes were compared. Results: A total of 205 patients for 209 procedures (143 RPN and 66 PTA) were included. In the PTA group, patients were older (80.4 ± 3.7 vs. 79 ± 3.7 years (p = 0.01)); frailer (ASA score (2.43 ± 0.6 vs. 2.17 ± 0.6 (p < 0.01)); and more frequently had a history of kidney surgery (16.7% [11/66] vs. 5.6% [8/143] (p = 0.01)) than in the RPN group. Tumors were larger in the RPN group (2.7 ± 0.7 vs. 3.2 ± 0.9 cm (p < 0.01)). Operation time, length of hospital stay, and increase of creatinine serum level were higher in RPN (respectively 92.1 ± 42.7 vs. 150.7 ± 61.3 min (p < 0.01); 1.7 ± 1.4 vs. 4.2 ± 3.4 days (p < 0.01); 1.9 ± 19.3% vs. 10.1 ± 23.7 (p = 0.03)). Disease-free survival and time to progression were similar (respectively, HR 2.2; 95% CI 0.88–5.5; p = 0.09; HR 2.1; 95% CI 0.86–5.2; p = 0.1). Overall survival was shorter for PTA that disappeared after Cox adjusting model (HR 3.3; 95% CI 0.87–12.72; p = 0.08). Conclusion: Similar oncological outcomes are observed after PTA and RPN for T1 RCC in elderly patients. Clinical relevance statement: Robot-assisted partial nephrectomy and percutaneous thermal ablation have similar oncological outcomes for T1a kidney cancer in patients over 75 years; however, operative time, decrease in renal function, and length of hospital stay were lower with ablation. Key Points: • After adjusting model for age and ASA score, similar oncological outcomes are observed after percutaneous thermal ablation and robot-assisted partial nephrectomy for T1 renal cell cancer in elderly patients. • Operation time, length of hospital stay, and increase of creatinine serum level were higher in the robot-assisted partial nephrectomy group. [ABSTRACT FROM AUTHOR]