sPaRT2-Minimally Invasive Partial vs Radical Nephrectomy for cT2 Renal Cell Carcinoma: A National Matched-Pair
Rajâa Et-Touzani1,2, Jean-Christophe Bernhard2,3,4, Thomas Prudhomme5
1Department of Urology, François Mitterrand University Hospital, Dijon, France.
Purpose:
Radical nephrectomy (RN) remains the standard treatment for cT2 renal cell carcinoma (RCC), but partial nephrectomy has emerged as a viable alternative with the development of robot-assisted approaches. However, robust comparative data between robot-assisted partial nephrectomy (RAPN) and RN for large renal tumors remain limited.
Materials And Methods:
We conducted a multicenter retrospective study using prospectively collected data from the UroCCR network (NCT03293563). Patients undergoing RAPN or minimally invasive RN for cT2M0 RCC were matched 1:1 using propensity scores based on clinical and tumor characteristics. Primary outcome was 5-year disease-free survival. Secondary end points included overall survival, renal function, perioperative outcomes, complications, and trifecta achievement.
Results:
Of 847 patients included, 250 RAPN and 250 RN were matched. The median tumor size was 8.2 cm in the RN group and 8 cm in the RAPN group. Oncologic outcomes were comparable: 5-year disease-free survival was 61% and 49% (P = .2), cancer-specific survival was 87% and 94% (P = .8), metastasis-free survival was 71% and 66% (P = .4), and overall survival was 80% and 80% (P = .5), for RAPN and RN, respectively. RAPN was associated with improved renal function preservation (median change in estimated glomerular filtration rate at 5 years: -15 vs -23 mL/min/1.73 m2), fewer chronic kidney disease stage migrations, and reduced acute kidney injury. Major complications were more frequent after RAPN (6% vs 2%, P = .04). The trifecta outcome was achieved in 46% of RAPN cases.
Conclusions:
RAPN is a safe and functionally superior alternative to RN for selected patients with cT2 RCC. While associated with higher perioperative morbidity, these risks are acceptable in expert centers and offset by long-term nephron-sparing benefits.
