Presentation Authors: Aaron Bradshaw*, San Diego, CA, Riccardo Autorino, Richmond, VA, Giuseppe Simone, Rome, Italy, Chao Zang, Shanghai, China, People's Republic of, Riccardo Bertolo, Juan Garisto, Cleveland, OH, Robert Uzzo, Philadelphia, PA, Umberto Capitanio, Milan, Italy, James Porter, Seattle, WA, Andrea Minervini, Florence, Italy, Daniel Eun, Philadelphia, PA, Clayton Lau, Patrick Kilday, Los Angeles, CA, Koon H. Rha, Seoul, Korea, Republic of, Alexander Mottrie, Aalst, Belgium, Wesley M. White, Knoxville, TN, Luigi Schips, Chieti and Pescara, Italy, Kenneth Jacobsohn, Milwaukee, WI, Ben Challacombe, London, United Kingdom, Matteo Ferro, Milan, Italy, Uzoma A. Anele, Richmond, VA, Gabriele Tuderti, Rome, Italy, Stephen Ryan, Ahmet Bindayi, San Diego, CA, Andrea Mari, Florence, Italy, Aryeh Keehn, Philadelphia, PA, Michael Liao, Seattle, WA, Alessandro Larcher, Milan, Italy, Geert de Naeyer, Aalst, Belgium, Peter Langenstroer, Milwaukee, WI, Alexander Kutikov, Philadelphia, PA, Francesco Montorsi, Milan, Italy, Georges-Pascal Haber, Cleveland, OH, Lance J. Hampton, Richmond, VA, Michele Gallucci, Rome, Italy, Bo Yang, Shanghai, China, People's Republic of, Chandru Sundaram, Indiannapolis, IN, Carmen M. Mir, Valencia, Spain, Akbar Ashrafi, Los Angeles, CA, Francesco Porpiglia, Turin, Italy, Jihad Kaouk, Cleveland, OH, Monish Aron, Los Angeles, CA, Ithaar Derweesh, San Diego, CA
Introduction: While emerging data suggest feasibility and safety of minimally invasive partial nephrectomy (MIS-PN) for T2a renal mass (T2aRM), comparative analyses to minimally invasive radical nephrectomy (MIS-RN) are limited. We conducted a propensity score-matched comparison of outcomes of MIS-RN and PN in clinical T2a renal mass utilizing a large multicenter registry.
Methods: Retrospective multicenter analysis of MIS-PN and RN for cT2aRM (T2aN0M0) [RObotic SUrgery for LArge renal mass (ROSULA) Group]. Cohorts were propensity matched for age, sex, BMI and clinical tumor size using a 2:1 ratio for RN:PN. Primary outcome was disease-free survival (DFS), with secondary outcomes of overall survival (OS), change in estimated glomerular filtration rate (Î´eGFR), de novo eGFR < 60 mL/min/1.73m2 and eGFR < 45. Cox Regression (MVA) and Kaplan-Meier analyses (KMA) were carried out for outcomes.
Results: 648 patients (216 PN/432 RN, median follow up 18 months) were matched. There was no significant difference in age (p=0.302), sex (p=0.505), BMI (p=0.221), or tumor size (RN 8.16 vs. PN 8.06 cm, p=0.10). No differences were noted in Clavien 3/4 complications (p=0.062) and readmissions (p=0.139). PN had lower Î´eGFR (9.4 vs. 24.4, p < 0.001), de novo eGFR < 60 (p < 0.001) and de novo eGFR < 45 (4.0% vs. 18.8%, p < 0.001). MVA revealed increasing ASA score (HR 2.7, p=0.044) and sarcomatoid histology (HR 5.3, p=0.001), but not surgery type (p=0.601) to be associated with worsened all-cause mortality. Pathologic upstaging (HR 2.5, p=0.010), high tumor grade (HR 2.7, p=0.016), and sarcomatoid histology (HR 2.4, p=0.033) were associated with recurrence, while surgery type (p=0.550) was not. Increasing age (HR 1.1, p < 0.001) and RN (HR 4.6, p =0.001) were predictors for de novo eGFR < 45. KMA showed 77.8% and 79.4% 5-year DFS for patients undergoing MIS-PN and RN, respectively (Figure 1; p=0.410), and 77.1% and 88.2% 5-year OS for patients who underwent MIS-PN and RN, respectively (p=0.280).
Conclusions: In a propensity matched cT2a cohort, MIS-PN demonstrated similar oncologic outcomes while conferring functional benefit. When feasible, MIS-PN may be considered as a viable option for select cT2a renal masses.