Percutaneous Ablation <i>vs</i> Robot-Assisted Partial Nephrectomy for Completely Endophytic Renal Masses: A Multicenter Trifecta Analysis with a Minimum 3-Year Follow-Up

Abstract

<b><i>Purpose</i></b><i>:</i> To compare outcomes of robot-assisted partial nephrectomy (RAPN) and percutaneous tumor ablation (PTA) for completely endophytic renal masses. <b><i>Methods</i></b><i>:</i> Data of patients who underwent RAPN or PTA for treatment of completely endophytic (three points for "E" domain of R.E.N.A.L. score) were collected from seven high-volume U.S. and European centers. PTA included cryoablation, radiofrequency, or microwave ablation. Baseline characteristics, clinical, surgical, and postoperative outcomes were compared. Recurrence-free survival (RFS) was calculated with Kaplan-Meier analysis. Trifecta was used as arbitrary combined outcome parameter as proxy for treatment "quality." Multivariable logistic regression model assessed predictors of trifecta failure. <b><i>Results</i></b><i>:</i> One hundred fifty-two patients (RAPN, <i>n</i> = 60; PTA, <i>n</i> = 92) were included in the analysis. RAPN group was younger (<i>p</i> < 0.001), had lower American Society of Anesthesiologists score (<i>p</i> = 0.002), and higher baseline estimated glomerular filtration rate (<i>p</i> < 0.001). There was no difference in clinical tumor size, clinical T stage, and tumor complexity scores. PTA had significantly lower rate of overall (<i>p</i> < 0.001) and minor (<i>p</i> < 0.001) complications. ΔeGFR at 1 year was statistically higher for RAPN (-15.5 mL/min <i>vs</i> -3.1 mL/min; <i>p</i> = 0.005), no difference in ΔeGFR at last follow-up (<i>p</i> = 0.22) was observed. No difference in recurrences (RAPN, <i>n</i> = 2; PTA, <i>n</i> = 6) and RFS was found (<i>p</i> = 0.154). Trifecta achievement was higher for RAPN but not statistically different (65.3% <i>vs</i> 58.8%; <i>p</i> = 0.477). R.E.N.A.L. Nephrometry Score resulted predictive of trifecta failure (odds ratio = 1.47; confidence interval = 1.13-1.90; <i>p</i> = 0.004). <b><i>Conclusions:</i></b> PTA confirms to be an effective treatment for completely endophytic renal masses, offering low complications and good mid-term functional and oncologic outcomes. These outcomes compare favorably with those of RAPN, which seem to be the preferred option for younger and less comorbid patients.