Introduction

Partial nephrectomy (PN) is the standard of care in the management of cT1a tumors, while radical nephrectomy (RN) is indicated in more advanced tumors. Recent studies provided evidence that PN could be performed in patients with tumors greater that 7 cm with complication rates and oncological outcomes comparable with those undergoing RN. _x000D_ The objective of the presenting study is to compare the recurrence-free survival (RFS), overall (OS) and cancer-specific survival (CSS) of PN and RN in patients with non-metastatic pathological T3a renal cell carcinoma (RCC) with perirenal fat invasion only.

Methods

We retrospectively reviewed 1202 patients undergoing RN (n=653) and PN (n=549), at a oncological referral center, from January 2003 to June 2016. Of all patients, we identified 25 RN and 41 PN pT3a tumors with exclusively perirenal fat invasion. None had nodal or distant metastasis at pre-treatment clinical staging. Patients characteristics were compared with Mann-Whitney U test and Student t-test for categorical and numeric variables with normal distribution, respectively. Both groups were compared for RFS, OS and CSS with a Kaplan-Meier survival analysis.

Results

All patients included had pT3a stage with isolated perirenal fat invasion. Groups undergoing Radical and Partial nephrectomy were not significantly different regarding Charlson Comorbidity Index (Median 3 for RN vs 4 for PN, p=0.24) or Age (Mean 65.3 for RN vs 62.0 for PN, p=0.99). Patients undergoing RN had bigger tumors (7.9 cm vs 4.6, p<0.001) and higher Fuhrman grade (p=0.01). Median follow-up was 36 months for RN and 34 months for PN. At the end of follow-up, recurrence was seen in 3 patients undergoing RN (12%) and 2 undergoing PN (5%), p=0.36. Mortality was similar across groups (16% for RN vs 15% for PN, p=0.99) as well as Cancer-specific mortality (4% for RN vs. 5% for PN, p=0.99). At the end of follow-up, RFS was 80% (20/25) for RN and 82% (34/41) for PN. (Figure 1)

Conclusions

In our data, renal cell carcinoma with T3 stage due to perirenal fat invasion exclusively had similar outcomes when treated with Radical or Partial Nephrectomy. OS as well as RFS were comparable for both surgical modalities, suggesting that, although RN is currently the gold standard for this staging, PN may provide similar oncologic results.

Funding

None