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Sarcomatoid and Aggressive Variants in High R.E.N.A.L. Score T1b RCC: Outcomes After Laparoscopic and Robotic Radical

Murad Asali1,2, Galeb Asali3, Ron Batash4

  • 1Urology Department, Barzilai Medical Center, Ben Gurion University of the Negev, Beer Sheva 8430905, Israel.

Cancers
|December 30, 2025
PubMed
Summary
This summary is machine-generated.

Laparoscopic radical nephrectomy (LRN) is safe for T1b renal cell carcinoma (RCC) with high R.E.N.A.L. scores, offering good oncological control and preserving kidney function. Aggressive pathological features were common, supporting LRN for these complex cases.

Keywords:
R.E.N.A.L. nephrometry scoreT1b RCClaparoscopic surgeryradical nephrectomyrenal cell carcinomarenal function preservation

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Area of Science:

  • Urology
  • Oncology
  • Surgical Pathology

Background:

  • Management of T1b renal cell carcinoma (RCC) with moderate-to-high R.E.N.A.L. nephrometry scores poses challenges.
  • While partial nephrectomy preserves renal function, optimal surgical approach for complex tumors is debated.

Purpose of the Study:

  • To evaluate outcomes of laparoscopic radical nephrectomy (LRN) for T1b RCC with moderate-to-high R.E.N.A.L. scores (≥8).
  • To assess the incidence and prognostic impact of sarcomatoid and other aggressive pathological variants in these cases.

Main Methods:

  • Retrospective analysis of 118 patients undergoing LRN for T1b RCC with R.E.N.A.L. scores ≥8 (2008-2024).
  • Primary outcomes: perioperative complications, renal function preservation, and pathological findings.
  • Follow-up included laboratory tests, ultrasounds, and CT scans up to 30 months postoperatively.

Main Results:

  • Mean R.E.N.A.L. score was 10.02; mean tumor diameter was 6.0 cm (CT) / 4.7 cm (pathology).
  • Mean operative time: 151.6 min; average blood loss: 75.2 mL; complication rate: 7.6% (9/118).
  • Aggressive pathological features (high grade, multiple tumors, variants) found in 29.7% of cases.

Conclusions:

  • LRN is a safe and effective option for T1b RCC with moderate-to-high R.E.N.A.L. scores.
  • LRN provides adequate oncological control and acceptable renal function preservation.
  • High incidence of aggressive features supports radical nephrectomy in this cohort.