- 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.
- 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.
- 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>