Robotic PN May Offer Better Outcomes Than RFA for T1a RCC

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Two-year recurrence-free survival was 100% vs 95.2% among robotic surgery and radiofrequency ablation patients, respectively.
Two-year recurrence-free survival was 100% vs 95.2% among robotic surgery and radiofrequency ablation patients, respectively.

Recurrence-free survival is higher after robotic partial nephrectomy (RPN) than radiofrequency ablation (RFA) for patients with T1a renal cell carcinoma (RCC), a new study suggests.

Seong Il Seo, MD, and colleagues from Sungkyunkwan University School of Medicine in Seoul, Korea, used propensity score-matching to compare oncological and functional outcomes between patients who underwent RPN and RFA, while minimizing selection bias. Sixty-three patients were matched by age, sex, American Society of Anesthesiologists score, tumor size, tumor laterality, tumor histology, RENAL nephrometry score, and preoperative estimated glomerular filtration rate (eGFR).

At 2 years, recurrence-free survival was 100% in the RPN and 95.2% in the RFA group, according to study findings published in European Radiology. “The RFA group had a lower recurrence-free survival rate than the RPN group, suggesting that RFA is inferior to RPN in treating patients with T1a RCC,” Dr Seo's team stated.

RPN and RFA did not differ significantly with respect to GFR preservation (91.7% vs 86.8%), major complications, and development of chronic kidney disease stage 3 or 4. Operative time (227 vs 82 min) and hospital stay (6.9 vs 1.1) were shorter for the RFA group.

However, RFA might more effectively treat endophytic tumors, according to investigators. Endophytic RCC occurred in 47.6% vs 27% of RFA and RPN patients, respectively. Exophytic RCC occurred in 52.4% vs 73.0%. In addition, repeat RFA is more feasible than RPN should RCC recur.

“Therefore, the likelihood of recurrent tumour should be discussed with patients if RFA is chosen instead of RPN for T1a RCC,” Dr Seo and his colleagues concluded. “However, RFA is considered a treatment option for an endophytic or recurrent RCC that is difficult to treat with RPN.”

In addition to the inherent limitations of a retrospective, case-controlled, single center study with relatively short follow-up, the authors noted that tumor location was not matched between treatment groups and eGFR of the treated kidney was not assessed. For these reasons, data from randomized controlled trials are still needed.  

Reference

Kwan Park B, Gong H, Kang MY, et al. RFA versus robotic partial nephrectomy for T1a renal cell carcinoma: a propensity score-matched comparison of mid-term outcome. Eur Radiol. doi:10.1007/s00330-018-5305-6

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