Percutaneous Ablation vs Robot-Assisted Partial Nephrectomy for Completely Endophytic Renal Masses: A Multicenter Trifecta Analysis with a Minimum 3-Year Follow-Up

Abstract

Purpose. To compare outcomes of robotic-assisted partial nephrectomy (RAPN) and percutaneous tumor ablation (PTA) for completely endophytic renal masses. Methods. Data of patients who underwent RAPN or PTA for treatment of completely endophytic (3 points for “E” domain of R.E.N.A.L. score) were collected from seven high-volume US and European centers. PTA included cryoablation, radiofrequency, or microwave ablation. Baseline characteristics, clinical, surgical, and postoperative outcomes were compared. Recurrence-free survival (RFS) was calculated with Kaplan-Maier. Trifecta was used as arbitrary combined outcome parameter as proxy for treatment “quality”. Multivariable logistic regression model assessed predictors of trifecta failure. Results. 152 patients (RAPN, n=60; PTA, n=92) were included in the analysis. RAPN group was younger (p<.001), had lower ASA score (p=0.002) and higher baseline eGFR (p<.001). No difference in clinical tumor size, clinical T stage, and tumor complexity scores. PTA had significantly lower rate of overall (p<0.001) and minor (p<0.001) complications. ΔeGFR at 1-yr was statistically higher for RAPN (-15.5 vs -3.1 ml/min; p=0.005), no difference in ΔeGFR at last follow-up (p=0.22) was observed. No difference in recurrences (RAPN, n=2; PTA, n=6) and RFS was found (p= 0.154). Trifecta achievement was higher for RAPN but not statistically different (65.3% vs 58.8%; p=0.477). RENAL score resulted predictive of trifecta failure (OR=1.47; CI=1.13-1.90; p=0.004). Conclusions. PTA confirms to be an effective treatment for completely endophytic renal masses, offering low complications, good mid-term functional and oncological outcomes. These outcomes compare favorably to those of RAPN, which remains the preferred NSS option for younger and less comorbid patients.