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ORIGINAL ARTICLE   Free accessfree

Minerva Urology and Nephrology 2021 August;73(4):509-17

DOI: 10.23736/S2724-6051.21.04390-1


language: English

Comparison between minimally-invasive partial and radical nephrectomy for the treatment of clinical T2 renal masses: results of a 10-year study in a tertiary care center

Daniele AMPARORE 1, 2 , Angela PECORARO 1, 2, Federico PIRAMIDE 1, Enrico CHECCUCCI 1, 3, Sabrina DE CILLIS 1, Gabriele VOLPI 1, Alberto PIANA 1, Paolo VERRI 1, Stefano GRANATO 1, Michele SICA 1, Matteo MANFREDI 1, Cristian FIORI 1, Francesco PORPIGLIA 1

1 Division of Urology, Department of Oncology, School of Medicine, University of Turin, San Luigi Gonzaga Hospital, Orbassano, Turin, Italy; 2 Renal Cancer Working Group of the Young Academic Urologists (YAU) Working Party of the European Association of Urology (EAU), Arnhem, the Netherlands; 3 Uro-technology and SoMe Working Group of the Young Academic Urologists (YAU) Working Party of the European Association of Urology (EAU), Arnhem, the Netherlands

BACKGROUND: Even if partial nephrectomy (PN) is nowadays considered the standard for managing cT1 renal masses, its role in the management of cT2 kidney tumors is controversial. We aimed to compare oncologic and functional outcomes of minimally invasive radical nephrectomy (RN) and PN in cT2 renal masses.
METHODS: Patients with cT2 renal masses underwent minimally-invasive PN or RN performed by a highly experienced single surgeon from 2009 to 2019 were considered. Demographic, perioperative and functional variables were compared. Cumulative incidence plot and competing risks regression (CRR) models were used to test differences in 5-year cancer-specific mortality (CSM) and 5-year other-cause mortality (OCM) rates. Kaplan-Meier and Cox regression model was used to test differences in 5-year progression free survival (PFS) rates.
RESULTS: Overall, 52 PN vs. 64 RN patients were identified. Relative to RN, PN patients recorded higher rates of complications (25% vs. 7.8%, P=0.02) but lower upstaging rate (≥pT3a 64.1% vs. 19.2%, P<0.0001). Functional outcomes were in favor of PN (all P<0.001). No differences were recorded between 5-year CSM and OCM according to nephrectomy type. At CRR models, older age and upstaging were independent predictors of 5-year OCM and CSM, respectively (all P<0.01). Finally, only upstaging, high grade tumors and presence of positive surgical margins were identified as independent predictors of 5-year PFS (all P<0.01).
CONCLUSIONS: In experienced hands the treatment of cT2 renal neoplasms with minimally-invasive PN is feasible, providing perioperative and oncological safety profiles comparable to RN, with advantages in terms of functional outcomes.

KEY WORDS: Kidney neoplasms; Nephrectomy; Minimally-invasive surgical procedures

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