RFA versus robotic partial nephrectomy for T1a renal cell carcinoma: a propensity score-matched comparison of mid-term outcome

• Published in: European radiology Vol. 28; no. 7; pp. 2979 - 2985
• Main Authors: Park, Byung Kwan, Gong, In Hyuck, Kang, Min Yong, Sung, Hyun Hwan, Jeon, Hwang Gyun, Jeong, Byong Chang, Jeon, Seong Soo, Lee, Hyun Moo, Seo, Seong Il
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01-07-2018; Springer Nature B.V
• Subjects: Aged; Carcinoma, Renal Cell - diagnostic imaging; Carcinoma, Renal Cell - pathology; Carcinoma, Renal Cell - surgery; Catheter Ablation - methods; Diagnostic Radiology; Endophytes; Epidermal growth factor receptors; Female; Glomerular Filtration Rate; Histology; Humans; Imaging; Internal Medicine; Interventional Radiology; Kidney - diagnostic imaging; Kidney - surgery; Kidney cancer; Kidney Neoplasms - diagnostic imaging; Kidney Neoplasms - pathology; Kidney Neoplasms - surgery; Male; Medicine; Medicine & Public Health; Middle Aged; Nephrectomy; Nephrectomy - methods; Neuroradiology; Oncology; Preservation; Propensity Score; Radio frequency; Radiography, Interventional - methods; Radiology; Renal cell carcinoma; Robotic Surgical Procedures; Survival; Survival Analysis; Tomography, X-Ray Computed - methods; Treatment Outcome; Tumors; Ultrasound; Radiofrequency catheter ablation; Treatment outcome; Carcinoma, Renal cell; Nephrectomy; Kidney
• ISSN: 0938-7994; 1432-1084
• DOI: 10.1007/s00330-018-5305-6

Objective
To compare oncological and functional mid-term outcomes following robotic partial nephrectomy (RPN) and radiofrequency ablation (RFA) for treating T1a renal cell carcinoma (RCC) using propensity score-matching.
Methods
Between December 2008–April 2016, 63 patients from each treatment group were propensity score-matched for age, sex, American Society of Anesthesiologists score, tumour size, tumour laterality, tumour histology, R.E.N.A.L. nephrometry score and preoperative estimated glomerular filtration rate (eGFR). Post-treatment follow-up periods for RPN and RFA ranged from 1–90 months (median, 24.6) and 1–65 months (21), respectively. Tumour location, percentage of eGFR preservation and 2-year recurrence-free survival rate were compared between groups.
Results
Exophytic and endophytic RCC occurred in 73.0 % (46/63) and 27.0 % (17/63) of the RPN group, and 52.4 % (33/63) and 47.6 % (30/63) of the RFA group, respectively (
p
=0.017). There was 91.7 % preservation of eGFR in the RPN group and 86.8 % in the RFA group (
p
=0.088). Two-year recurrence-free survival rate was 100 % in the RPN and 95.2 % in the RFA group (
p
=0.029).
Conclusions
RPN provides a higher recurrence-free survival rate than RFA. However, RFA is a better treatment option for an endophytic or recurrent RCC that is difficult to treat with RPN.
Key Points
• RPN provides a higher recurrence-free survival rate than RFA.
• Unlike RPN, repeat RFA is easy to perform for recurrent RCC.
• Endophytic RCC could be better treated with RFA.