Aaron W Bradshaw1, Riccardo Autorino2, Giuseppe Simone3, Bo Yang4, Robert G Uzzo5, Francesco Porpiglia6, Umberto Capitanio7, James Porter8, Riccardo Bertolo9, Andrea Minervini10, Clayton Lau11, Kenneth Jacobsohn12, Akbar Ashrafi13, Daniel Eun14, Alexandre Mottrie15, Wesley M White16, Luigi Schips17, Benjamin J Challacombe18, Ottavio De Cobelli19, Carmen M Mir20, Alessandro Veccia2, Alessandro Larcher7, Alexander Kutikov5, Monish Aron13, Prokar Dasgupta18, Francesco Montorsi7, Inderbir S Gill13, Chandru P Sundaram21, Jihad Kaouk9, Ithaar H Derweesh1. 1. Department of Urology, UC San Diego School of Medicine, La Jolla, CA, USA. 2. Division of Urology, VCU Health System, Richmond, VA, USA. 3. Department of Urology, IRCCS-"Regina Elena" National Cancer Institute, Rome, Italy. 4. Department of Urology, Changhai Hospital, Shanghai, China. 5. Division of Urology and Urologic Oncology, Fox Chase Cancer Center, Philadelphia, USA. 6. Department of Urology, University of Turin-San Luigi Gonzaga Hospital, Turin, Italy. 7. Unit of Urology, Division of Experimental Oncology, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy. 8. Swedish Urology Group, Seattle, WA, USA. 9. Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA. 10. Department of Urology, Careggi Hospital, University of Florence, Florence, Italy. 11. Division of Urology and Urologic Oncology, City of Hope National Medical Center, Duarte, CA, USA. 12. Department of Urology, Medical College Wisconsin, Milwaukee, WI, USA. 13. Institute of Urology, University of Southern California Keck School of Medicine, Los Angeles, CA, USA. 14. Department of Urology, Lewis Katz School of Medicine at Temple University, Philadelphia, PA, USA. 15. Department of Urology, OLV Hospital, Aalst, Belgium. 16. Department of Urology, University of Tennessee Medical Center, Knoxville, TN, USA. 17. Department of Urology, SS Annunziata Hospital, "G.D'Annunzio" University of Chieti, Chieti, Italy. 18. Urology Centre, Guy's and St Thomas's NHS Foundation Trust, London, UK. 19. Division of Urology, European Institute of Oncology, Milan, Italy. 20. Department of Urology, Fundacion Instituto Valenciano Oncologia, Valencia, Spain. 21. Department of Urology, Indiana University Health, Indianapolis, IN, USA.
Abstract
OBJECTIVE: To compare outcomes of minimally invasive radical nephrectomy (MIS-RN) and robot-assisted partial nephrectomy (RAPN) in clinical T2a renal mass (cT2aRM). PATIENTS AND METHODS: Retrospective, multicentre, propensity score-matched (PSM) comparison of RAPN and MIS-RN for cT2aRM (T2aN0M0). Cohorts were PSM for age, sex, body mass index, American Society of Anesthesiologists (ASA) class, clinical tumour size, and R.E.N.A.L. score using a 2:1 ratio for RN:PN. The primary outcome was disease-free survival (DFS). Secondary outcomes included overall survival (OS), complication rates, and de novo estimated glomerular filtration rate (eGFR) <45 mL/min/1.73 m2 . Multivariable (MVA) and Kaplan-Meier survival analyses (KMSA) were conducted. RESULTS: In all, 648 patients (216 RAPN/432 MIS-RN) were matched. There were no significant differences in intraoperative complications (P = 0.478), Clavien-Dindo Grade ≥III complications (P = 0.063), and re-admissions (P = 0.238). The MVA revealed high ASA class (hazard ratio [HR] 2.7, P = 0.044) and sarcomatoid (HR 5.3, P = 0.001), but not surgery type (P = 0.601) to be associated with all-cause mortality. Increasing R.E.N.A.L. score (HR 1.31, P = 0.037), high tumour grade (HR 2.5, P = 0.043), and sarcomatoid (HR 2.8, P = 0.02) were associated with recurrence, but not surgery (P = 0.555). Increasing age (HR 1.1, P < 0.001) and RN (HR 3.9, P < 0.001) were predictors of de novo eGFR of <45 mL/min/1.73 m2 . Comparing RAPN and MIS-RN, KMSA revealed no significant differences for 5-year OS (76.3% vs 88.0%, P = 0.221) and 5-year DFS (78.6% vs 85.3%, P = 0.630) for pT2 RCC, and no differences for 3-year OS (P = 0.351) and 3-year DFS (P = 0.117) for pT3a upstaged RCC. The 5-year freedom from de novo eGFR of <45 mL/min/1.73 m2 was 91.6% for RAPN vs 68.9% for MIS-RN (P < 0.001). CONCLUSIONS: RAPN had similar oncological outcomes and morbidity profile as MIS-RN, while conferring functional benefit. RAPN may be considered as a first-line option for cT2aRM.
OBJECTIVE: To compare outcomes of minimally invasive radical nephrectomy (MIS-RN) and robot-assisted partial nephrectomy (RAPN) in clinical T2a renal mass (cT2aRM). PATIENTS AND METHODS: Retrospective, multicentre, propensity score-matched (PSM) comparison of RAPN and MIS-RN for cT2aRM (T2aN0M0). Cohorts were PSM for age, sex, body mass index, American Society of Anesthesiologists (ASA) class, clinical tumour size, and R.E.N.A.L. score using a 2:1 ratio for RN:PN. The primary outcome was disease-free survival (DFS). Secondary outcomes included overall survival (OS), complication rates, and de novo estimated glomerular filtration rate (eGFR) <45 mL/min/1.73 m2 . Multivariable (MVA) and Kaplan-Meier survival analyses (KMSA) were conducted. RESULTS: In all, 648 patients (216 RAPN/432 MIS-RN) were matched. There were no significant differences in intraoperative complications (P = 0.478), Clavien-Dindo Grade ≥III complications (P = 0.063), and re-admissions (P = 0.238). The MVA revealed high ASA class (hazard ratio [HR] 2.7, P = 0.044) and sarcomatoid (HR 5.3, P = 0.001), but not surgery type (P = 0.601) to be associated with all-cause mortality. Increasing R.E.N.A.L. score (HR 1.31, P = 0.037), high tumour grade (HR 2.5, P = 0.043), and sarcomatoid (HR 2.8, P = 0.02) were associated with recurrence, but not surgery (P = 0.555). Increasing age (HR 1.1, P < 0.001) and RN (HR 3.9, P < 0.001) were predictors of de novo eGFR of <45 mL/min/1.73 m2 . Comparing RAPN and MIS-RN, KMSA revealed no significant differences for 5-year OS (76.3% vs 88.0%, P = 0.221) and 5-year DFS (78.6% vs 85.3%, P = 0.630) for pT2 RCC, and no differences for 3-year OS (P = 0.351) and 3-year DFS (P = 0.117) for pT3a upstaged RCC. The 5-year freedom from de novo eGFR of <45 mL/min/1.73 m2 was 91.6% for RAPN vs 68.9% for MIS-RN (P < 0.001). CONCLUSIONS: RAPN had similar oncological outcomes and morbidity profile as MIS-RN, while conferring functional benefit. RAPN may be considered as a first-line option for cT2aRM.
Authors: Fabio Crocerossa; Cristian Fiori; Umberto Capitanio; Andrea Minervini; Umberto Carbonara; Savio D Pandolfo; Davide Loizzo; Daniel D Eun; Alessandro Larcher; Andrea Mari; Antonio Andrea Grosso; Fabrizio Di Maida; Lance J Hampton; Francesco Cantiello; Rocco Damiano; Francesco Porpiglia; Riccardo Autorino Journal: Eur Urol Open Sci Date: 2022-03-03
Authors: Jasmin Runtemund; Johannes Rübenthaler; Niklas von Münchhausen; Maria Ingenerf; Freba Grawe; Gloria Biechele; Felix Gerhard Gassert; Fabian Tollens; Johann Rink; Sasa Cecatka; Christine Schmid-Tannwald; Matthias F Froelich; Dirk-André Clevert; Moritz L Schnitzer Journal: Cancers (Basel) Date: 2022-04-29 Impact factor: 6.575