Robotic partial nephrectomy vs minimally invasive radical nephrectomy for clinical T2a renal mass: a propensity score-matched comparison from the ROSULA (Robotic Surgery for Large Renal Mass) Collaborative Group: BJU International

A.W. Bradshaw, R. Autorino, G. Simone, B. Yang, R.G. Uzzo, F. Porpiglia, U. Capitanio, J. Porter, R. Bertolo, A. Minervini, C. Lau, K. Jacobsohn, A. Ashrafi, D. Eun, A. Mottrie, W.M. White, L. Schips, B.J. Challacombe, O. De Cobelli, C.M. MirA. Veccia, A. Larcher, A. Kutikov, M. Aron, P. Dasgupta, F. Montorsi, I.S. Gill, C.P. Sundaram, J. Kaouk, I.H. Derweesh

Research output: Contribution to journalArticlepeer-review

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. © 2020 The Authors BJU International © 2020 BJU International Published by John Wiley & Sons Ltd
Original languageEnglish
Pages (from-to)114-123
Number of pages10
JournalBJU Int.
Volume126
Issue number1
DOIs
Publication statusPublished - 2020

Keywords

  • carcinoma, renal cell
  • chronic kidney disease
  • disease-free survival
  • nephrectomy
  • robot-assisted partial nephrectomy
  • Stage 2
  • adult
  • aging
  • all cause mortality
  • Article
  • body mass
  • cancer recurrence
  • cancer staging
  • cohort analysis
  • disease free survival
  • estimated glomerular filtration rate
  • female
  • hospital readmission
  • human
  • intermethod comparison
  • intersectoral collaboration
  • kidney tumor
  • major clinical study
  • male
  • middle aged
  • multicenter study
  • overall survival
  • partial nephrectomy
  • postoperative complication
  • predictor variable
  • priority journal
  • radical nephrectomy
  • renal cell carcinoma
  • RENAL score
  • retrospective study
  • robot assisted surgery
  • sarcomatoid carcinoma
  • scoring system
  • sex ratio
  • treatment outcome
  • tumor volume
  • clinical trial
  • comparative study
  • procedures
  • propensity score
  • x-ray computed tomography
  • Carcinoma, Renal Cell
  • Disease-Free Survival
  • Female
  • Humans
  • Kidney Neoplasms
  • Male
  • Middle Aged
  • Neoplasm Staging
  • Nephrectomy
  • Propensity Score
  • Retrospective Studies
  • Robotic Surgical Procedures
  • Tomography, X-Ray Computed
  • Treatment Outcome

Fingerprint Dive into the research topics of 'Robotic partial nephrectomy vs minimally invasive radical nephrectomy for clinical T2a renal mass: a propensity score-matched comparison from the ROSULA (Robotic Surgery for Large Renal Mass) Collaborative Group: BJU International'. Together they form a unique fingerprint.

Cite this