Pandolfo Savio Domenico, Loizzo Davide, Beksac Alp T, Derweesh Ithaar, Celia Antonio, Bianchi Lorenzo, Elbich Jeffrey, Costa Giovanni, Carbonara Umberto, Lucarelli Giuseppe, Cerrato Clara, Meagher Margaret, Ditonno Pasquale, Hampton Lance J, Basile Giuseppe, Kim Fernando J, Schiavina Riccardo, Capitanio Umberto, Kaouk Jihad, Autorino Riccardo
Division of Urology & Massey Cancer Center, VCU Health, Richmond, VA, USA; Department of Neurosciences, Reproductive Sciences and Odontostomatology, Urology Unit, University of Naples "Federico II", Napoli, Italy.
Division of Urology & Massey Cancer Center, VCU Health, Richmond, VA, USA; Department of Emergency and Organ Transplantation-Urology, Andrology and Kidney Transplantation Unit, University of Bari, Bari, Italy.
Eur J Surg Oncol. 2023 Feb;49(2):486-490. doi: 10.1016/j.ejso.2022.09.022. Epub 2022 Oct 4.
Renal cell carcinoma (RCC) in solitary kidney (SK) represents a challenging scenario. We sought to compare outcomes of robot-assisted partial nephrectomy (RAPN) versus percutaneous thermal ablation (PTA) in SK patients with renal tumors cT1.
We performed a multicenter retrospective analysis of SK patients treated for RCC. The PTA group included cryoablation or radiofrequency ablation. We collected baseline characteristics, intraoperative, pathological, and post-operative data. We applied an arbitrary composite "trifecta" to assess surgical, functional, and oncological outcomes, only for malignant histology. RFS analysis was performed using the Kaplan-Meier method. Multivariable regression analysis was performed to determine independent predictors of "trifecta" achievement.
We included 198 SK patients (RAPN, n = 50; PTA n = 119). Mean clinical tumor size was not significantly different while R.E.N.A.L. score was higher for RAPN (p < 0.001). No differences in intra and major post-procedural complications. Recurrence rate was higher in PTA group but not statistically significant (p < 0.328). No difference in metastasis rate was found (p = 0.435). RFS was 96.1% in RAPN and 86.8% in PTA cohort (p = 0.003) while no difference in PFS was detected (p = 0.1). Trifecta was achieved in 72.5% of RAPN vs 77.3% of PTA (p = 0.481). Multivariable analysis has not detected predictors for Trifecta achievement.
PTA offers good outcomes in the management of SK patients with RCC. Compared with RAPN, it might carry a higher risk of recurrence; on the other hand, re-treatment is possible. Overall, PTA can be safely offered to treat SK patients presenting RCC. In general, it should be preferred in more frail patients to minimize the risk of complications.
孤立肾（SK）中的肾细胞癌（RCC）是一种具有挑战性的情况。我们试图比较机器人辅助部分肾切除术（RAPN）与经皮热消融术（PTA）在cT1期肾肿瘤的SK患者中的治疗效果。
我们对接受RCC治疗的SK患者进行了多中心回顾性分析。PTA组包括冷冻消融或射频消融。我们收集了基线特征、术中、病理和术后数据。我们应用一个任意的综合“三连胜”指标来评估手术、功能和肿瘤学结果，仅针对恶性组织学。采用Kaplan-Meier方法进行无复发生存期（RFS）分析。进行多变量回归分析以确定“三连胜”达成的独立预测因素。
我们纳入了198例SK患者（RAPN组，n = 50；PTA组，n = 119）。平均临床肿瘤大小无显著差异，但RAPN组的R.E.N.A.L.评分更高（p < 0.001）。术中及主要术后并发症无差异。PTA组的复发率较高，但无统计学意义（p < 0.328）。转移率无差异（p = 0.435）。RAPN组的RFS为96.1%，PTA组为86.8%（p = 0.003），而无进展生存期（PFS）无差异（p = 0.1）。RAPN组的“三连胜”达成率为72.5%，PTA组为77.3%（p = 0.481）。多变量分析未检测到“三连胜”达成的预测因素。
PTA在SK合并RCC患者的治疗中提供了良好的效果。与RAPN相比，它可能具有更高的复发风险；另一方面，再次治疗是可行的。总体而言，PTA可安全地用于治疗患有RCC的SK患者。一般来说，对于身体更虚弱的患者应优先选择PTA，以将并发症风险降至最低。
