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Partial nephrectomy versus ablative therapy for the treatment of renal tumors in an imperative setting

Jean-Alexandre Long 1, 2, * Jean-Christophe Bernhard 3 Pierre Bigot 4 Cécilia Lanchon 5 Philippe Paparel 6 Nathalie Rioux-Leclercq 7 Laurence Albiges 8 Thomas Bodin 9 François-Xavier Nouhaud 10 Romain Boissier 11 Pierre Gimel 12 Arnaud Mejean 13 Alexandra Masson-Lecomte 14 Nicolas Grenier 15 François Cornelis 16 Yohann Grassano 17 Vincent Comat 17 Quentin Come Le Clerc 18 Jérôme Rigaud 18 Laurent J. Salomon 19 Jean-Luc Descotes 1, 2 Christian Sengel 20 Morgan Rouprêt 21 Gregory Verhoest 7 Idir Ouzaid 19 Valentin Arnoux 5 Karim Bensalah 22 
Abstract : Purpose - To compare partial nephrectomy (PN) and percutaneous ablative therapy (AT) for renal tumor in imperative indication of nephron-sparing technique (NST). Materials and methods - Between 2000 and 2015, 284 consecutive patients with a kidney tumor in an imperative indication of NST were retrospectively included in a multicenter study. PN [open (n = 146), laparoscopic (n = 9), or robotic approach (n = 17)] and AT [radiofrequency ablation (n = 104) or cryoablation (n = 8)] were performed for solitary kidney (n = 146), bilateral tumor (n = 78), or chronic kidney disease (CKD) (n = 60). Results - Patients in the PN group had larger tumors and a higher RENAL score. There were no differences between the two groups with respect to age, reasons for imperative indication, and preoperative eGFR. Patients in the AT group had a higher ASA and CCI. PN had worse outcomes than AT in terms of transfusion rate, length of stay, and complication rate. Local radiological recurrence-free survival was better for PN, but metastatic recurrence was similar. Percentage of eGFR decrease was similar in the two groups. Temporary or permanent dialysis was not significantly different. On multivariate analysis, PN and AT had a similar eGFR change when adjusted for tumor complexity, reason of imperative indication and CCI. Conclusion - In imperative indication of nephron-sparing treatment for a kidney tumor, either PN or AT can be proposed. PN offers the ability to manage larger and more complex tumors while providing a better local control and a similar renal function loss.
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Submitted on : Tuesday, May 15, 2018 - 5:50:20 PM
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Jean-Alexandre Long, Jean-Christophe Bernhard, Pierre Bigot, Cécilia Lanchon, Philippe Paparel, et al.. Partial nephrectomy versus ablative therapy for the treatment of renal tumors in an imperative setting. World Journal of Urology, 2017, 35 (4), pp.649 - 656. ⟨10.1007/s00345-016-1913-4⟩. ⟨hal-01792768⟩



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