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

• DOI: 10.1007/s00345-016-1913-4
• Publication Date: 2016-08-06T15:24:33Z
• Authors: Jean-Alexandre Long; Jean-Christophe B...; Pierre Bigot; Cecilia Lanchon; Philippe Paparel; Nathalie Rioux-Le...; Laurence Albiges; Thomas Bodin; François-Xavier N...; Romain Boissier; Pierre Gimel; Arnaud Méjean; Alexandra Masson-...; Nicolas Grenier; Francois Cornelis; Yohann Grassano; Vincent Comat; Quentin Come Le C...; Jérome Rigaud; Laurent Salomon; Jean-Luc Descotes; Christian Sengel; Morgan Roupret; Gregory Verhoest; Idir Ouzaid; Valentin Arnoux; Karim Bensalah
• Keywords: Cryoablation; Ablation Techniques; Male; [SDV]Life Sciences [q-bio]; Comorbidity; Imperative indication; Kidney; Cryosurgery; Disease-Free Survival; Congenital Abnormalities; 03 medical and health sciences; 0302 clinical medicine; 616; Partial nephrectomy; Humans; Blood Transfusion; Carcinoma, Renal Cell; Aged; Length of Stay; Middle Aged; Kidney Neoplasms; 3. Good health; [SDV] Life Sciences [q-bio]; Renal cancer; Radiofrequency; Multivariate Analysis; Catheter Ablation; Female; Kidney Diseases; Laparoscopy; Glomerular Filtration Rate

To compare partial nephrectomy (PN) and percutaneous ablative therapy (AT) for renal tumor in imperative indication of nephron-sparing technique (NST).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).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.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.