Kidney-sparing treatments are salvage options for renal cell carcinoma (RCC) after local recurrence. However, there is no level 1 evidence in the literature examining the efficacy of focal therapies (FTs) and partial nephrectomy (PN) in a head-to-head, randomised comparison.
A systematic search (PROSPERO CRD420251033642) was performed. The present analysis adhered to the Preferred Reporting Items for Systematic Reviews and Meta-analyses statement.
Overall, 30 studies involving 873 patients were included in the final analysis. Patients with RCC were treated primarily with FTs (n = 376, 43%) and PN (n = 462, 53%). Of FTs, cryoablation was received by 198 (57%) RCC patients. The rates of recurrence for FTs ranged from 4% to 20%, while those for PN ranged from 3% to 19%. The intraoperative complication rates ranged from 2% to 6% for FTs and from 3% to 9% for PN. The postoperative complications rates ranged from 2% to 40% for FTs and from 8% to 40% for PN, while the major postoperative complications rates, defined as Clavien-Dindo ≥3, ranged from 2% to 9% for FTs and from 1% to 18% for PN. The rates of overall survival ranged from 82% to 100% for FTs, and from 96% to 100% for PNs. Limitations included the bias in patients' selection and the absence of time-to-event data.
PN achieved acceptable overall survival, recurrence, and complication profiles, demonstrating its feasibility in a salvage setting. Patient selection is mandatory to identify those best candidates for PN and FT, thereby prioritising oncological outcomes.
European urology focus. 2025 Dec 17 [Epub ahead of print]
Francesco Di Bello, Andrea Gallioli, Alessandro Uleri, Gernot Ortner, Bhaskar Kumar Somani, Tiago Ribeiro de Oliveira, Eric Barret, Panagiotis Kallidonis, Giulio Avesani, Nicola Longo, Alberto Breda, Theodoros Tokas, EAU Section of Endourology Focal/Laparoscopy Working Group
Department of Urology, Fundació Puigvert, Barcelona, Spain; Department of Neurosciences, Science of Reproduction and Odontostomatology, University of Naples Federico II, Naples, Italy. Electronic address: ., Department of Urology, Fundació Puigvert, Barcelona, Spain; Institut de Recerca Sant Pau (IR SANT PAU), Barcelona, Spain., Department of Urology UROSUD, La Croix du Sud Hospital, Quint Fonsegrives, France., Training and Research in Urological Surgery and Technology (T.R.U.S.T.) Group, Hall in Tirol, Austria; Department of Urology and Andrology, General Hospital Hall i.T, Hall in Tirol, Austria., University Hospital Southampton NHS Trust, University of Southampton, Southampton, UK., Hospital das Forças Armadas, Lisbon, Portugal., Department of Urology, Institut Mutualiste Montsouris, Paris, France., Department of Urology, University Hospital of Patras, Patras, Greece., Department of Urology, Fundació Puigvert, Barcelona, Spain; Department of Urology and Division of Experimental Oncology/Unit of Urology, Urological Research Institute (URI), IRCCS San Raffaele Scientific Institute, Milan, Italy., Department of Urology, Fundació Puigvert, Barcelona, Spain; Department of Neurosciences, Science of Reproduction and Odontostomatology, University of Naples Federico II, Naples, Italy., Training and Research in Urological Surgery and Technology (T.R.U.S.T.) Group, Hall in Tirol, Austria; Department of Urology, University General Hospital of Heraklion, University of Crete, Medical School, Heraklion, Greece.
PubMed http://www.ncbi.nlm.nih.gov/pubmed/41412889