Percutaneous Ablation vs Robot-Assisted Partial Nephrectomy for Completely Endophytic Renal Masses: A Multicenter...

Area of Science:

• Urology
• Oncology
• Minimally Invasive Surgery

Background:

• Endophytic renal masses pose unique treatment challenges.
• Robot-assisted partial nephrectomy (RAPN) and percutaneous tumor ablation (PTA) are minimally invasive options.
• Comparing outcomes is crucial for guiding treatment decisions.

Purpose of the Study:

• To compare the clinical, surgical, and oncologic outcomes of RAPN and PTA for completely endophytic renal masses.
• To evaluate recurrence-free survival (RFS) and treatment quality using the trifecta outcome.
• To identify predictors of treatment failure.

Main Methods:

• Retrospective analysis of 152 patients (60 RAPN, 92 PTA) from high-volume centers.
• Data included baseline characteristics, complications, estimated glomerular filtration rate (eGFR) changes, recurrence rates, and trifecta achievement.
• Kaplan-Meier analysis for RFS and multivariable logistic regression for trifecta failure predictors.

Main Results:

• PTA group had significantly lower overall and minor complication rates.
• No significant difference in recurrence rates or RFS between groups.
• Trifecta achievement was similar (65.3% RAPN vs. 58.8% PTA).
• R.E.N.A.L. Nephrometry Score predicted trifecta failure (OR 1.47, p=0.004).

Conclusions:

• PTA is an effective treatment for endophytic renal masses, demonstrating low complications and favorable mid-term functional and oncologic outcomes.
• Outcomes compare favorably with RAPN, suggesting PTA as a viable alternative.
• RAPN may be more suitable for younger patients with fewer comorbidities.