Partial nephrectomy for renal cell carcinoma (RCC) with a minimally invasive approach is not associated with worse oncologic outcomes compared with an open procedure, a recent study suggests.
In fact, minimally invasive modalities resulted in a lower risk for recurrence and death from any cause, investigators reported in Urologic Oncology.
The finding supports previous reports suggesting that minimally invasive surgery is not associated with increased risk for port-site incisional or peritoneal seeding, they noted.
“There have been a few anecdotal arguments that minimal invasive renal surgery is not safe and puts patients at a higher risk of tumor recurrence,” said lead investigator Reza Mehrazin, MD, associate professor of urologic oncology at the Icahn School of Medicine at Mount Sinai in New York, New York. “This multicenter study shows that this is not true.”
Dr Mehrazin and colleagues studied a cohort of 2440 patients who underwent partial nephrectomy at 2 urban quaternary referral centers and identified 190 patients who underwent an open partial nephrectomy (OPN) and 190 propensity score-matched patients who underwent a minimally invasive partial nephrectomy (MIPN), either laparoscopic or robotic-assisted. The median follow-up duration was significantly longer in the OPN than the MIPN group (59 vs 23 months).
Cancer recurrence was significantly more common in the OPN group than the MIPN group (10% vs 3.2%), Dr Mehrazin’s team reported. The surgical approach did not predict location of recurrence. Time to recurrence did not differ significantly between the OPN and MIPN groups (23.8 and 26.3 months, respectively). On multivariable analysis, OPN was significantly associated with a 3.9-fold increased risk for recurrence compared with MIPN. The all-cause mortality rate was significantly higher in the OPN group (10.5% vs 2.6%).
“There likely remains some patient selection bias that is unaccounted for in the statistical analysis,” the authors wrote. “Nevertheless, the design of this study is concrete, and the outcomes should warrant reconsideration of the current opinion that OPN and MIPN result in equivalent long-term oncological outcomes.”
Tam AW, Kutikov A, Winoker S, et al. Propensity-score matched oncological outcomes and patterns of recurrence following open and minimally-invasive partial nephrectomy for renal cell carcinoma. Urol Oncol. Published online February 6, 2022. doi:10.1016/j.urolonc.2021.12.011