医学
肾切除术
围手术期
肾细胞癌
肾功能
经皮
临床终点
外科
泌尿科
烧蚀
肾
内科学
随机对照试验
作者
Clément Klein,G. Cazalas,G. Margue,Gilles Piana,É. de Kerviler,Afshin Gangi,Phillipe Puech,C. Nedelcu,Rémi Grange,Xavier Buy,C. Michiels,Marc-Antoine Jegonday,Olivier Rouvière,N. Grenier,Clément Marcelin,Jean-Christophe Bernhard
出处
期刊:Minerva urology and nephrology
[Edizioni Minerva Medica]
日期:2023-09-01
卷期号:75 (5)
标识
DOI:10.23736/s2724-6051.23.05274-6
摘要
BACKGROUND: Partial nephrectomy (PN) is the gold standard treatment for cT1b renal tumors. Percutaneous guided thermal ablation (TA) has proven oncologic efficacy with low morbidity for the treatment of small renal masses (<3 cm). Recently, 3D image-guided robot-assisted PN (3D-IGRAPN) has been described, and decreased perioperative morbidity compared to standard RAPN has been reported. Our objective was to compare two minimally invasive image-guided nephron-sparing procedures (TA vs. 3D-IGRAPN) for the treatment of cT1b renal cell carcinomas (4.1-7 cm).METHODS: Patients treated with TA and 3D-IGRAPN for cT1b renal cell carcinoma, prospectively included in the UroCCR database (NCT 03293563), were pair-matched for tumor size, pathology, and RENAL score. The primary endpoint was the local recurrence rate between the two groups. Secondary endpoints included metastatic evolution, perioperative complications, decrease in renal function, and length of hospitalization.RESULTS: A total of 198 patients were included and matched into two groups of 72 patients. The local recurrence rate was significantly higher in the TA group than that in the 3D-IGRAPN group (4.2% vs. 15.2%, P=0.04). Metastatic evolution and perioperative outcomes such as major complications, eGFR decrease, and length of hospitalization did not differ significantly between the two groups.CONCLUSIONS: 3D-IGRAPN resulted in a significantly lower local recurrence rate and comparable rates of complications and metastatic evolution compared with thermal ablation.
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