Abstract No. 641 Single-institution analysis of renal cell carcinoma treatment modalities: nephrectomy versus ablation

Abstract

Renal cell carcinoma (RCC) accounts for roughly 3% of adult malignancies and 95% of primary kidney neoplasms. Increasing earlier diagnosis of the disease, specifically in the case of small renal masses (SRM) (<4 cm) has been noted, with 74,000 new cases of RCC in the US in 2019. Treatment options for SRM patients ranges from active surveillance to ablative therapy, to surgery with varying standard guideline recommendations depending on comorbidities and staging. This study evaluated outcomes of patients with SRM T1a RCC that underwent nephrectomies and/or ablations. Following IRB approval, a retrospective chart review of 351 patients at Beaumont Royal Oak diagnosed with SRM RCC from 1996-2019 was completed. Patient data including demographics, comorbidities, intraoperative complications, and outcomes were collected and compared between patients who received a nephrectomy or ablation. 155 SRM patients included 64 nephrectomies in 63 patients, 166 ablations in 139 patients. Four patients received both treatments. Mean follow-up length was 23 months. Patients managed surgically were younger (70 years vs. 74, P = 0.0002) and had a longer length of stay (3.5 days vs. 1.0, P <0.0001). The total number of procedures was less for those receiving surgery (P = 0.006). Comorbidities were similar between groups, with a higher percentage of ablation patients with underlying type II diabetes (31% vs. 16% surgery patients, P = 0.043). Intraoperative complications that included postop ileus, ARDS, pneumothorax, urinary retention, hematoma was significantly different (P = 0.038). While there were 22 recurrences in the ablation group, there were only 2 observed in surgical patients. There were no observed differences in the number of EC visits within 30 days of the index procedure, nor were there differences in the overall outcomes. This study found that patients had similar demographics and comorbidities, but underwent different initial management for their RCC. Long-term outcomes in the two groups were similar, but differences in initial therapy led to different management courses. Future studies will compare the cost-effectiveness of these two management strategies.