Perioperative, oncological and functional outcomes after robotic partial nephrectomy vs. cryoablation in the elderly: A propensity score matched analysis.
Urol Oncol
; 37(4): 294.e9-294.e15, 2019 04.
Article
em En
| MEDLINE
| ID: mdl-30691958
OBJECTIVE: To compare perioperative, oncological and functional outcomes of robotic partial nephrectomy (RPN) versus cryoablation in elderly patients (>75 years old), accounting for patient's and tumor's related factors. METHODS: Retrospective institutional review of 312 consecutive elderly patients (> 75 years old) who underwent RPN or cryoablation for renal mass (June 2006-December 2016). Demographic, perioperative, functional, and oncological data were evaluated. Sixty-five patients who underwent RPN were propensity-score matched 1:1 to 65 who underwent cryoablation (matching was based on demographics, renal function, comorbidities and tumor characteristics). Perioperative outcomes were compared. Survival analysis was performed to estimate overall (OS), recurrence-free (RFS) and cancer-specific survival (CSS) by Kaplan-Meier method. A linear mixed effect model (LME) estimated the effect of follow-up on estimated glomerular filtration rate (eGFR). RESULTS: After matching, the variables were well balanced with no differences at baseline between groups. Shorter operative time and lower blood losses favored cryoablation (140 vs. 200 min, P < 0.0001 and 100 vs. 195 ml, Pâ¯=â¯0.0002, respectively). Overall complications rate was higher for RPN (31% vs. 9%; Pâ¯=â¯0.007), but no difference was found in major (Clavien III-IV) complications (6% vs. 1.5%, Pâ¯=â¯0.2). At a median follow-up of 37 (29-44) and 46 (38-53) months for RPN and cryoablation, no significant differences were found in CSS (100% vs. 95%, Pâ¯=â¯0.3) and OS (80% vs. 75%, Pâ¯=â¯0.2) but RFS was higher for RPN (100% vs. 83%, RPN vs. cryoablation, respectively, Pâ¯=â¯0.02). eGFR was comparable between the groups at every time point analyzed. CONCLUSIONS: Although with a higher rate of recurrences, our data confirm cryoablation as a lower morbidity profile treatment option for small renal masses in the elderly population, with cancer-specific survival comparable to surgery.
Palavras-chave
Texto completo:
1
Coleções:
01-internacional
Base de dados:
MEDLINE
Assunto principal:
Criocirurgia
/
Período Perioperatório
/
Nefrectomia
Tipo de estudo:
Observational_studies
/
Prognostic_studies
Limite:
Aged
/
Female
/
Humans
/
Male
Idioma:
En
Ano de publicação:
2019
Tipo de documento:
Article