Robotic minimally invasive partial nephrectomy (PN) for large renal tumors is associated with oncologic outcomes similar to those of robotic radical nephrectomy (RN), but PN offers an advantage with regard to preserved renal function, according to study data presented at the 34th Annual European Association of Urology Congress in Barcelona, Spain.
The study included 648 patients who underwent robotic surgery for cT2a renal masses. The group included 216 patients who underwent PN and a propensity score matched group of 332 patients who underwent RN. Patients had a median follow-up of 18 months. The PN and RN groups had 5-year disease-free survival rates of 77.8% and 79.4%, respectively, and 5-year overall survival rates of 77.1% and 88.2%, respectively, investigator Ithaar Derweesh, MD, of the University of California, San Diego, reported. The differences in rates between the groups were not statistically significant.
In addition, the PN group experienced smaller declines in estimated glomerular filtration rate (-9.4 vs -24.4 mL/min/1.73 m2). Smaller proportions of the PN than RN groups experienced a decline in eGFR to below 45 mL/min/1.73 m2 (4% vs 18.8%) and below 60 mL/min/1.73 m2 (9.4% vs 24.4%).
On multivariate analysis, RN was associated with a 4.6-fold increased risk of de novo eGFR less than 45 mL/min/1.73 m2 compared with PN. In addition, higher ASA score and sarcomatoid histology, but not surgery type, were associated with worse all-cause mortality. Pathologic upstaging and high tumor grade, but not surgery type, predicted an increased risk of recurrence.
Dr Derweesh and his colleagues concluded that robotic PN, when feasible, may be considered as a viable option for select cT2a renal masses.
Bradshaw A, Autorino R, Simone G, et al. Propensity score matched comparison of minimally invasive partial and radical nephrectomy for clinical T2a renal mass: Analysis of the robotic surgery for large renal mass (ROSULA) group. Presented at the 34th Annual European Association Urology Congress in Barcelona, Spain. Abstract 338.