Minimally invasive nephron-sparing treatments for T1 renal cell cancer in patients over 75 years: a comparison of outcomes after robot-assisted partial nephrectomy and percutaneous ablation

Purpose To compare the oncological and perioperative outcomes of robot-assisted partial nephrectomy (RPN) and percutaneous thermal ablation (PTA) for treatment of T1 renal cell cancer (RCC) in patients older than 75 years. Materials and methods Retrospective national multicenter study included all patients older than 75 years treated for a T1 RCC by RPN or PTA between January 2010 and January 2021. Patients’ characteristics, tumor data, and perioperative and oncological outcomes were compared. Results A total of 205 patients for 209 procedures (143 RPN and 66 PTA) were included. In the PTA group, patients were older (80.4 ± 3.7 vs. 79 ± 3.7 years ( p = 0.01)); frailer (ASA score (2.43 ± 0.6 vs. 2.17 ± 0.6 ( p < 0.01)); and more frequently had a history of kidney surgery (16.7% [11/66] vs. 5.6% [8/143] ( p = 0.01)) than in the RPN group. Tumors were larger in the RPN group (2.7 ± 0.7 vs. 3.2 ± 0.9 cm ( p < 0.01)). Operation time, length of hospital stay, and increase of creatinine serum level were higher in RPN (respectively 92.1 ± 42.7 vs. 150.7 ± 61.3 min ( p < 0.01); 1.7 ± 1.4 vs. 4.2 ± 3.4 days ( p < 0.01); 1.9 ± 19.3% vs. 10.1 ± 23.7 ( p = 0.03)). Disease-free survival and time to progression were similar (respectively, HR 2.2; 95% CI 0.88–5.5; p = 0.09; HR 2.1; 95% CI 0.86–5.2; p = 0.1). Overall survival was shorter for PTA that disappeared after Cox adjusting model (HR 3.3; 95% CI 0.87–12.72; p = 0.08). Conclusion Similar oncological outcomes are observed after PTA and RPN for T1 RCC in elderly patients. Clinical relevance statement Robot-assisted partial nephrectomy and percutaneous thermal ablation have similar oncological outcomes for T1a kidney cancer in patients over 75 years; however, operative time, decrease in renal function, and length of hospital stay were lower with ablation. Key Points • After adjusting model for age and ASA score, similar oncological outcomes are observed after percutaneous thermal ablation and robot-assisted partial nephrectomy for T1 renal cell cancer in elderly patients . • Operation time, length of hospital stay, and increase of creatinine serum level were higher in the robot-assisted partial nephrectomy group.