| Affiliation: | 1.Urology Department,Grenoble University Hospital,Grenoble,France;2.TIMC-IMAG Laboratory, UMR CNRS 5525,Grenoble,France;3.Urology Department,Bordeaux University Hospital,Bordeaux,France;4.Urology Department,Angers University Hospital,Angers,France;5.Urology Department,Lyon-Sud University Hospital,Pierre-Bénite,France;6.Pathology Department,Rennes University Hospital,Rennes,France;7.Oncology Department,Gustave Roussy Institute,Paris,France;8.Prado-Louvain Urology Center,Marseille,France;9.Urology Department,Rouen University Hospital,Rouen,France;10.Urology Department,La Conception University Hospital,Marseille,France;11.Urology Department,Medipole,Cabestany,France;12.Urology Department,Georges Pompidou University Hospital,Paris,France;13.Urology Department,Mondor University Hospital,Creteil,France;14.Radiology Department,Bordeaux University Hospital,Pessac,France;15.Urology Department,Nantes University Hospital,Nantes,France;16.Radiology Department,Grenoble University Hospital,La Tronche,France;17.Urology Department,La Pitie-Salpetriere University Hospital,Paris,France;18.Urology Department,Rennes University Hospital,Rennes,France;19.Urology Department,Bichat University Hospital,Paris,France;20.Urology Department,Annecy-Genevois Hospital,Metz-Tessy,France |
| Abstract: | PurposeTo compare partial nephrectomy (PN) and percutaneous ablative therapy (AT) for renal tumor in imperative indication of nephron-sparing technique (NST).Materials and methodsBetween 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).Results 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.ConclusionIn 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. |
