Introduction

Minimally-invasive treatments of clinically localized renal tumors such as robot-assisted partial nephrectomy (RAPN) and percutaneous Thermal Ablations (TA) are routinely performed in our institution. The objectives were to describe our indications and assess the morbidity and the efficacy of each one of the techniques

Methods

. From our prospectively maintained database UroCCR (French national Database on Kidney Cancer), we retrospectively reviewed RAPN and TA procedures performed between 2003 and 2016. Pre-operative, intra-operative, postoperative and follow up data were collected. Chi2 and Wilcoxon tests were used for comparisons. Kaplan Meier curves and Log rank test were used to determine survivals and predictive factors of local recurrence.

Results

We reviewed 397 procedures including, 232 RAPN and 165 TA. RAPN patients were younger (61 vs 73 yo, p<0.001), less often solitary kidney (4.9% vs 34.8%, p<0.001) or bilateral tumor (p<0.001) and had a lower ASA score. Post-operative complications occurred in 34 and 18 cases after RAPN and TA respectively (14.6% vs 10.8%, p=0.08). RAPN patients had more post-operative transfusion (7.7% vs 0.6%, p<0.001) and the Clavien grade of complications was higher (p=0,016). There was no difference on post-operative glomerular filtration rate (GFR) between the 2 groups (-5.3 vs -5.6 ml/min/1.73m2, p=0.32). Among the 342 patients with a proven malignant tumor, the rate of local recurrence, metastatic progression and death were lower with RAPN (3%, 2.4%, 1.9%, respectively) than TA (17.5%, 10.3%, 13.8%, p<0.001). In multivariate analysis, the only independent predictive factor of local recurrence was the endophytic character of the tumor OR 3.51 (1.01-12.20), p=0.04

Conclusions

RAPN and TA allow offering a safe minimally invasive treatment whatever the patients profile is. Post-operative renal function and complication rates were not significantly different between the 2 groups. However, we experienced more major complications after RAPN and more local recurrence after TA

Funding

none