Perioperative, oncological and functional outcomes after robotic partial nephrectomy vs. cryoablation in the elderly: A propensity score matched analysis.
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, P = 0.0002, respectively). Overall complications rate was higher for RPN (31% vs. 9%; P = 0.007), but no difference was found in major (Clavien III-IV) complications (6% vs. 1.5%, P = 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%, P = 0.3) and OS (80% vs. 75%, P = 0.2) but RFS was higher for RPN (100% vs. 83%, RPN vs. cryoablation, respectively, P = 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.
['Bertolo|Riccardo|R|', 'Garisto|Juan|J|', 'Armanyous|Sherif|S|', 'Agudelo|Jose|J|', 'Lioudis|Michael|M|', 'Kaouk|Jihad|J|']
D000368:Aged D003452:Cryosurgery D005260:Female D006801:Humans D008297:Male D009392:Nephrectomy D059035:Perioperative Period D057216:Propensity Score D012189:Retrospective Studies D065287:Robotic Surgical Procedures D016896:Treatment Outcome
Robot Partial nephrectomy Cryoablation Elderly Nephron-sparing Renal neoplasm