Large renal masses: partial and radical nephrectomy show similar survival, complications

  • Bradshaw AW & al.
  • BJU Int
  • 31 Mar 2020

  • curated by Deepa Koli
  • Univadis Clinical Summaries
Access to the full content of this site is available only to registered healthcare professionals. Access to the full content of this site is available only to registered healthcare professionals.

Takeaway

  • In patients with clinical T2a renal mass, robotic-assisted partial nephrectomy vs minimally invasive radical nephrectomy shows:
    • No significant difference in survival, recurrence, and complications.
    • Preserves renal function.

Why this matters

  • Partial nephrectomy should be preferred in this setting.

Study design

  • Propensity-score-matched analysis: 648 patients with clinical T2a renal mass received minimally invasive radical nephrectomy (n=432) or robotic-assisted partial nephrectomy (n=216).
  • Funding: Stephen Weissman Kidney Cancer Research Fund.

Key results

  • With partial vs radical nephrectomy, no difference in:
    • 5-year OS in pT2 group (76.3% vs 88.0%; P=.221).
    • 5-year DFS in pT2 group (78.6% vs 85.3%; P=.630).
    • 3-year OS in pT3 upstaged group (83.2% vs 87.2%; P=.351).
    • 3-year DFS in pT3 upstaged group (71.3% vs 60.4%; P=.117).
    • Intraoperative transfusion (4.3% vs 1.9%; P=.115).
    • Intraoperative complications (6.9% vs 5.3%; P=.478).
    • Major complications (5.3% vs 2.3%; P=.063).
    • Recurrence/metastasis rate (8.8% vs 12.7%; P=.151).
  • Increasing RENAL score (HR, 1.31; P=.037), high nuclear grade (HR, 2.48; P=.043), and sarcomatoid differentiation (HR, 2.79; P=.02) were independent risk factors for recurrence.
  • Surgery type was not associated with recurrence (P=.555).
  • Radical nephrectomy was independently associated with estimated glomerular filtration rate 2 (HR, 3.85; P<.001>
  • 5-year freedom from de novo CKD stage III was significantly higher with partial nephrectomy (67.4% vs 29.9%; P<.001>

 Limitations

  • Retrospective.