Percutaneous Ablation versus Robot-Assisted Partial Nephrectomy for Completely Endophytic Renal Masses: A Multicenter Trifecta Analysis with a Minimum 3-year Follow-up.

To compare outcomes of robotic-assisted partial nephrectomy (RAPN) and percutaneous tumor ablation (PTA) for completely endophytic renal masses.

Data of patients who underwent RAPN or PTA for treatment of completely endophytic (3 points for "E" domain of R.

E.N.A.L. score) were collected from seven high-volume US and European centers. PTA included cryoablation, radiofrequency, or microwave ablation. Baseline characteristics, clinical, surgical, and postoperative outcomes were compared. Recurrence-free survival (RFS) was calculated with Kaplan-Maier. Trifecta was used as arbitrary combined outcome parameter as proxy for treatment "quality". Multivariable logistic regression model assessed predictors of trifecta failure.

152 patients (RAPN, n=60; PTA, n=92) were included in the analysis. RAPN group was younger (p<.001), had lower ASA score (p=0.002) and higher baseline eGFR (p<.001). No difference in clinical tumor size, clinical T stage, and tumor complexity scores. PTA had significantly lower rate of overall (p<0.001) and minor (p<0.001) complications. ΔeGFR at 1-yr was statistically higher for RAPN (-15.5 vs -3.1 ml/min; p=0.005), no difference in ΔeGFR at last follow-up (p=0.22) was observed. No difference in recurrences (RAPN, n=2; PTA, n=6) and RFS was found (p= 0.154). Trifecta achievement was higher for RAPN but not statistically different (65.3% vs 58.8%; p=0.477). RENAL score resulted predictive of trifecta failure (OR=1.47; CI=1.13-1.90; p=0.004).

PTA confirms to be an effective treatment for completely endophytic renal masses, offering low complications, good mid-term functional and oncological outcomes. These outcomes compare favorably to those of RAPN, which remains the preferred NSS option for younger and less comorbid patients.

Journal of endourology. 2022 Nov 11 [Epub ahead of print]

Savio Domenico Pandolfo, Alp Beksac, Ithaar H Derweesh, Antonio Celia, Riccardo Schiavina, Lorenzo Bianchi, Giovanni Costa, Umberto Carbonara, Davide Loizzo, Giuseppe Lucarelli, Clara Cerrato, Ciro Imbimbo, Vincenzo Mirone, Jeffrey Elbich, Giuseppe Basile, Lance J Hampton, Fernando Kim, Umberto Capitanio, Jihad Kaouk, Riccardo Autorino

Division of Urology & Massey Cancer Center, VCU Health, Richmond, VA, USA, 1Division of Urology & Massey Cancer Center, VCU H, Virginia, United States., Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA, Cleveland, United States; ., Department of Urology, University of California San Diego School of Medicine, La Jolla, CA, USA, La Jolla, California, United States; ., Department of Urology, San Bassiano Hospital, Bassano Del Grappa, Italy, Bassano del Grappa, Italy; ., Division of Urology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy; ., Universita degli Studi di Bologna Azienda Ospedaliera Sant'Orsola-Malpighi, 18508, Urology, Via P. Palagi 9, Bologna, Bologna, RN, Italy, 40138; ., Department of Urology, San Bassiano Hospital, Bassano Del Grappa, Italy, Bassano del grappa, United States; ., Virginia Commonwealth University Health System, 6887, Department of Urology, 11200 E BROAD ST, RICHMOND, Richmond, Virginia, United States, 23233., Division of Urology & Massey Cancer Center, VCU Health, Richmond, richmond, United States; ., Dept. of Emergency and Organ Transplantation - Urology and Kidney Transplantation Unit, Bari, Italy; ., Department of Urology, University of California San Diego School of Medicine, La Jolla, CA, USA, Verona, Italy; ., Department of Neurosciences, Reproductive Sciences and Odontostomatology, Urology Unit, University of Naples "Federico II", Napoli, Italy, Naples, Italy; ., Department of Neurosciences, Reproductive Sciences and Odontostomatology, Urology Unit, University of Naples "Federico II", Napoli, Italy, Naples, Italy; ., Department of Radiology, Vascular Interventional Radiology, VCU Health, Richmond, Virginia, Richmond, United States; ., Department of Urology, San Raffaele Scientific Institute, Milan, Division of Experimental Oncology/Unit of Urology; URI; IRCCS San Raffaele Hospital, Milan, Italy, MIlan, Italy; ., Richmond, United States; ., Division of Urology, Denver Health Medical Center, Denver, CO, USA, denver, United States; ., 9Department of Urology, San Raffaele Scientific In, Italy; ., Cleveland, United States; ., Virginia Commonwealth University Health System, 6887, Surgery (Urology), 1200 East Broad st, Richmond, Virginia, United States, 23298; .

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