Rate Of Partial Nephrectomy Research Articles

Three-dimensional virtual models assistance predicts higher rates of "successful" minimally invasive partial nephrectomy: an Institutional analysis across the available trifecta definitions.

3D virtual models (3DVMs) are nowadays under scrutiny to improve partial nephrectomy (PN) outcomes. Five different Trifecta definitions have been proposed to optimize the framing of "success" in the PN field. Our aim is to analyze if the use of 3DVMs could impact the success rate of minimally invasive PN (mi-PN), according to the currently available definitions of Trifecta. At our Institution 250 cT1-2N0M0 renal masses patients treated with mi-PN were prospectively enrolled. Inclusion criteria were the availability of contrast-enhanced CT, baseline and postoperative serum creatinine, and eGFR. These patients were then compared with a control group of 710 patients who underwent mi-PN with the same renal function assessments, but without 3DVMs. Multivariable logistic regression (MLR) models were used to predict the trifecta achievement according to the different trifecta definitions. Among the definitions, Trifecta rates ranged between 70.8% to 97.4% in the 3DVM group vs. 56.8% to 92.8% in the control group (all p values < 0.05). 3DVMs showed better postoperative outcomes in terms of ΔeGFR, ( - 16.6% vs. - 2.7%, p = 0.03), postoperative complications (15%, vs 22.9%, p = 0.002) and major complications (Clavien Dindo > 3, 2.8% vs 5.6%, p = 0.03). At MLR 3DVMs assistance independently predicted higher rates of successful PN across all the available definitions of Trifecta (OR: 2.7 p < 0.001, OR:2.0 p = 0.0008, OR:2.8 p = 0.02, OR 2.0 p = 0.003). The 3DVMs availability was found to be the constant predictive factor of successful PN, with a twofold higher probability of achieving Trifecta regardless of the different definitions available in Literature.

PD37-03 DOES NEOADJUVANT CHEMOTHERAPY REDUCE THE COMPLEXITY OF WILMS TUMOR? AN ANALYSIS USING THE NEPHROMETRY SCORE

You have accessJournal of UrologyCME1 Apr 2023PD37-03 DOES NEOADJUVANT CHEMOTHERAPY REDUCE THE COMPLEXITY OF WILMS TUMOR? AN ANALYSIS USING THE NEPHROMETRY SCORE Catherine Nguyen, Eric Bih, Kathleen Hosek, Michelle Dai, and Niccolo Passoni Catherine NguyenCatherine Nguyen More articles by this author , Eric BihEric Bih More articles by this author , Kathleen HosekKathleen Hosek More articles by this author , Michelle DaiMichelle Dai More articles by this author , and Niccolo PassoniNiccolo Passoni More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003335.03AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Per the Children’s Oncology Group (COG) protocols, partial nephrectomy (PN) for Wilms tumor (WT) is reserved for bilateral tumors or lesions in solitary kidneys. Furthermore, most WTs are large masses that would not be amenable to partial nephrectomy. Unlike COG, the Societe Internationale d’Oncologie Pediatrique (SIOP) offers neoadjuvant chemotherapy (NAC) prior to surgical resection, allowing for tumor shrinkage. The Nephrometry score (NS) is a tool that was developed to assess the complexity of renal cell carcinoma, and thus the feasibility of partial nephrectomy. It relies on morphological features of tumors seen on cross-sectional imaging. The NS was however developed for renal cell carcinoma. Only one study to date has assessed Wilms tumors using the NS, showing that most are highly complex lesions not amenable to (PN). The goal of our study is to assess if NAC decreases the complexity of Wilms tumor using the NS. METHODS: We retrospectively identified patients with WT at our institution who received NAC (according to COG protocols). Pre- and post- treatment tumor volumes and NS were calculated by a single radiologist. For bilateral or multifocal tumors, the score was calculated for the most complex mass. NS was broken down into low, intermediate and high complexity groups. Rates of PN were stratified by NS score and by pre-operative variables. Statistical differences were assessed using paired t-tests and chi square tests. RESULTS: 54 patients were identified. The median pre- and post-treatment tumor volumes were 499 and 90 cm3, respectively (p<0.0001). Before NAC, NS was considered low, intermediate and high in 3.7%, 13% and 83.3% of patients, respectively. After NAC, the NS score was low, intermediate and high in 11.1%, 25.9% and 63% of patients. Fourteen tumors (26%) had their complexity downgraded. Overall rates of PN were 35% (n=19). There were statistically significant higher rates of PN for tumors with a low NS (83%) vs intermediate (64.3%) and high (14.7%) scores (p<0.0001). Among pre-operative variables such as age, sex, race, ethnicity, syndromic Wilms and stage, only female sex was statistically associated with higher rates of downgrading after NAC (36% vs 9.5% of males, p=0.028). CONCLUSIONS: The majority of WT are complex masses. Our data shows that NAC can reduce tumor complexity in 26% of cases, with more than half the patients with low or intermediate complexity WT undergoing successful PN. Further studies are needed to identify which patients with unilateral non-syndromic WT could benefit from NAC with the goal of nephron-sparing surgery. Source of Funding: Department © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e987 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Catherine Nguyen More articles by this author Eric Bih More articles by this author Kathleen Hosek More articles by this author Michelle Dai More articles by this author Niccolo Passoni More articles by this author Expand All Advertisement PDF downloadLoading ...

MP58-10 INSTITUTIONAL ANALYSIS OF TRIFECTA DEFINITIONS: 3D VIRTUAL MODELS PREDICT HIGHER RATES OF 'SUCCESSFUL' MINIMALLY INVASIVE PARTIAL NEPHRECTOMY

You have accessJournal of UrologyCME1 Apr 2023MP58-10 INSTITUTIONAL ANALYSIS OF TRIFECTA DEFINITIONS: 3D VIRTUAL MODELS PREDICT HIGHER RATES OF 'SUCCESSFUL' MINIMALLY INVASIVE PARTIAL NEPHRECTOMY Daniele Amparore, Angela Pecoraro, Federico Piramide, Enrico Checcucci, Sabrina De Cillis, Alberto Piana, Gabriele Volpi, Davide Zamengo, Alberto Quarà, Giovanni Busacca, Marco Colombo, Dalia Cidda, Cecilia Gatti, Michele Ortenzi, Martina Mandaletti, Michele Sica, Paolo Verri, Matteo Manfredi, Cristian Fiori, and Francesco Porpiglia Daniele AmparoreDaniele Amparore More articles by this author , Angela PecoraroAngela Pecoraro More articles by this author , Federico PiramideFederico Piramide More articles by this author , Enrico CheccucciEnrico Checcucci More articles by this author , Sabrina De CillisSabrina De Cillis More articles by this author , Alberto PianaAlberto Piana More articles by this author , Gabriele VolpiGabriele Volpi More articles by this author , Davide ZamengoDavide Zamengo More articles by this author , Alberto QuaràAlberto Quarà More articles by this author , Giovanni BusaccaGiovanni Busacca More articles by this author , Marco ColomboMarco Colombo More articles by this author , Dalia CiddaDalia Cidda More articles by this author , Cecilia GattiCecilia Gatti More articles by this author , Michele OrtenziMichele Ortenzi More articles by this author , Martina MandalettiMartina Mandaletti More articles by this author , Michele SicaMichele Sica More articles by this author , Paolo VerriPaolo Verri More articles by this author , Matteo ManfrediMatteo Manfredi More articles by this author , Cristian FioriCristian Fiori More articles by this author , and Francesco PorpigliaFrancesco Porpiglia More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003311.10AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: 3D virtual models (3DVMs) are nowadays under scrutiny to improve partial nephrectomy (PN) outcomes. Over the year, five different Trifecta definitions have been proposed to optimize the framing of “success” in the PN field. The aim of the present study was to analyze if the use of 3DVMs could impact the success rate of minimally-invasive PN, according to the currently available definitions of Trifecta. METHODS: At our Institution 250 cT1-2N0M0 renal masses patients treated with minimally-invasive PN were prospectively enrolled. Inclusion criteria were the availability of contrast-enhanced CT from which a 3DVM was obtained, baseline and postoperative serum creatinine, and eGFR. These patients were then compared with a control group of 710 patients who underwent minimally-invasive PN with the same renal function assessments, but without 3DVMs. Trifecta rate was defined for each of the currently available definitions, after stratification according to 3DVMs availability. Multivariable logistic regression (MLR) models were used to predict the trifecta achievement according to the different trifecta definitions. RESULTS: Overall, 960 patients met the inclusion criteria. Among the definitions, Trifecta rates ranged between 70.8% to 97.4% in the 3DVM group vs. 56.8% to 92.8% in the control group (all p values<0.05). 3DVMs showed better postoperative outcomes in terms of ΔeGFR, (-16.6% vs. -2.7%, p=0.03), postoperative complications (15%, vs 22.9%, p=0.002) and major complications (Clavien Dindo >3, 2.8% vs 5.6%, p=0.03). At MLR 3DVMs assistance independently predicted higher rates of successful PN across all the available definitions of Trifecta (OR: 2.7 p<0.001, OR:2.0 p=0.0008, OR:2.8 p=0.02, OR 2.0 p=0.003). CONCLUSIONS: There was large variability in the rates of Trifecta according to different definitions, but always in favor of those PN assisted by 3DVMs. Their availability was found to be the constant predictive factor of successful PN, with a 2-fold higher probability of achieving Trifecta regardless of the different definitions available in Literature and justifying their introduction in clinical practice. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e799 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Daniele Amparore More articles by this author Angela Pecoraro More articles by this author Federico Piramide More articles by this author Enrico Checcucci More articles by this author Sabrina De Cillis More articles by this author Alberto Piana More articles by this author Gabriele Volpi More articles by this author Davide Zamengo More articles by this author Alberto Quarà More articles by this author Giovanni Busacca More articles by this author Marco Colombo More articles by this author Dalia Cidda More articles by this author Cecilia Gatti More articles by this author Michele Ortenzi More articles by this author Martina Mandaletti More articles by this author Michele Sica More articles by this author Paolo Verri More articles by this author Matteo Manfredi More articles by this author Cristian Fiori More articles by this author Francesco Porpiglia More articles by this author Expand All Advertisement PDF downloadLoading ...

Race-Modified Equations Estimating Renal Function and the Disparity in Partial Nephrectomy Use in Black Patients

Purpose: Black patients with renal tumors are less likely to undergo partial nephrectomy (PN) despite a higher risk of chronic kidney disease (CKD). Racialized equations estimating glomerular filtration rate (eGFR) estimate a 15% to 20% higher renal function for Black patients as opposed to non-Black patients. Whether raced-modified eGFR equations affect the use of nephron-sparing surgery in Black patients has not yet been explored. Materials and Methods: This is a single-center, retrospective review of 6327 consecutive patients who underwent PN (n = 3533) or radical nephrectomy (RN) (n = 2794) from 2005 to 2020. Patients were asked to self-report their race preoperatively. We excluded patients with a tumor thrombus (n = 149). Data were dichotomized into Black patients (n = 654) and non-Black patients (n = 5673). Multivariable logistic regression analysis controlled for known factors associated with PN. The impact of the race-modified (2009CKD-EPI) and race-free (2021CKD-EPI-refit) equations on the distribution of patients across CKD stages was analyzed. Results: Among 6327 patients, 10.3% were Black patients. Black patients had higher comorbidity rates and lower preoperative eGFR than non-Black patients (P &lt; .001). Black patients had lower overall PN rates than non-Black patients (49% vs 57%; P &lt; .001), a finding that was most pronounced in the CKD stage 1 group (55.84% vs 67.43%; P = .0011). On multivariable logistic regression analysis, the Black race was associated with lower odds of PN (OR = 0.76 (0.61-0.96), P = .001). CKD-EPI-refit moved 27% of Black patients to a lower and more accurate CKD stage. Conclusions: Using a conventional race-modified equation potentially overestimated the renal function of 27% of Black patients who were restaged into worse CKD stages when using the race-free equation. While the surgical approach is multifactorial, race-modified equations may overestimate renal function in a significant portion of Black patients and explain some, but not all, of the observed lower utilization of nephron-sparing surgical approaches in Black patients.

MP24-01 RACE BASED EQUATIONS FOR ESTIMATING KIDNEY FUNCTION MAY CONTRIBUTE TO RACIAL DISPARITIES IN PARTIAL NEPHRECTOMY UTILIZATION AMONG BLACK PATIENTS WITH KIDNEY TUMORS

You have accessJournal of UrologyCME1 May 2022MP24-01 RACE BASED EQUATIONS FOR ESTIMATING KIDNEY FUNCTION MAY CONTRIBUTE TO RACIAL DISPARITIES IN PARTIAL NEPHRECTOMY UTILIZATION AMONG BLACK PATIENTS WITH KIDNEY TUMORS Nour Abdallah, Tarik Benidir, Martin Hofmann, Eiftu Haile, Diego Aguilar Palacios, Venkatesh Krishnamurthi, Samuel Haywood, Mohamed Eltemamy, Jihad Kaouk, Robert Abouassaly, Steven Campbell, and Christopher Weight Nour AbdallahNour Abdallah More articles by this author , Tarik BenidirTarik Benidir More articles by this author , Martin HofmannMartin Hofmann More articles by this author , Eiftu HaileEiftu Haile More articles by this author , Diego Aguilar PalaciosDiego Aguilar Palacios More articles by this author , Venkatesh KrishnamurthiVenkatesh Krishnamurthi More articles by this author , Samuel HaywoodSamuel Haywood More articles by this author , Mohamed EltemamyMohamed Eltemamy More articles by this author , Jihad KaoukJihad Kaouk More articles by this author , Robert AbouassalyRobert Abouassaly More articles by this author , Steven CampbellSteven Campbell More articles by this author , and Christopher WeightChristopher Weight More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002563.01AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Population based studies have found that black Americans with renal tumors are less likely to undergo a partial nephrectomy (PN) compared to non-black Americans despite their increased risk for chronic kidney disease (CKD). Guidelines suggest assessment of renal function, tumor size and location to determine whether to perform a PN or radical nephrectomy (RN). However, commonly used equations to predict renal function are racialized and estimate a 15-20% higher glomerular filtration rate (eGFR) if the patient is black compared to non-black patients. We hypothesize that these racialized estimates of eGFR may contribute to the lower utilization of PN in blacks. METHODS: From 2005 to 2020, we included 6476 consecutive patients undergoing either PN or RN with known self-reported race and preoperative (preop) creatinine at Cleveland Clinic. Data was dichotomized into Black (n=668) and non-Black patients (n=5808) and compared across preop variables and surgery types. Multivariable regression analysis was used to identify predictors of PN. We also stratified PN rates across CKD stages for blacks and non-blacks. RESULTS: The cohorts’ preop variables are listed in Table 1. Black patients had higher rates of diabetes, hypertension, had higher comorbidity scores and lower baseline eGFR. On multivariable logistic regression analysis, black patients were less likely to be treated via PN (Odds Ratio (OR)=0.75, Confidence interval (CI)=[0.63-0.89], p=0.001), even when controlling for body mass index, age-adjusted Charlson comorbidity index, hypertension, preop eGFR, tumor size and complexity. When comparing PN rates across CKD stages, PN utilization was similar for all stages except stage 1, where the odds of getting a PN were 39% lower for black patients compared to non-blacks (OR 0.61, [0.46-0.82], p=0.01). CONCLUSIONS: Black patients were less likely to undergo PN, despite lower baseline kidney function and higher comorbidity rates. This disparity was most marked in patients with high estimated renal function. Racialized kidney function equations may contribute, along with access and other unknown factors to the disparity seen in the use of kidney preservation strategies for black patients with renal masses. Source of Funding: None © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e392 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Nour Abdallah More articles by this author Tarik Benidir More articles by this author Martin Hofmann More articles by this author Eiftu Haile More articles by this author Diego Aguilar Palacios More articles by this author Venkatesh Krishnamurthi More articles by this author Samuel Haywood More articles by this author Mohamed Eltemamy More articles by this author Jihad Kaouk More articles by this author Robert Abouassaly More articles by this author Steven Campbell More articles by this author Christopher Weight More articles by this author Expand All Advertisement PDF downloadLoading ...

MP47-06 ASSESSING RENAL MASS MANAGEMENT OF PATIENTS WITH INCREASED COMORBIDITIES: RESULTS FROM A STATEWIDE REGISTRY

You have accessJournal of UrologyCME1 May 2022MP47-06 ASSESSING RENAL MASS MANAGEMENT OF PATIENTS WITH INCREASED COMORBIDITIES: RESULTS FROM A STATEWIDE REGISTRY Mohit Butaney, Amit Patel, Ji Qi, Karandeep Singh, Anna Johnson, Alison Levy, Sabrina Noyes, Khurshid Ghani, Craig Rogers, and Brian Lane Mohit ButaneyMohit Butaney More articles by this author , Amit PatelAmit Patel More articles by this author , Ji QiJi Qi More articles by this author , Karandeep SinghKarandeep Singh More articles by this author , Anna JohnsonAnna Johnson More articles by this author , Alison LevyAlison Levy More articles by this author , Sabrina NoyesSabrina Noyes More articles by this author , Khurshid GhaniKhurshid Ghani More articles by this author , Craig RogersCraig Rogers More articles by this author , and Brian LaneBrian Lane More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002618.06AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Partial nephrectomy (PN) has been associated with a higher risk of perioperative complications and morbidity than radical nephrectomy (RN). Based on MUSIC’s experience with Notable Outcomes and Trackable Events after Surgery (NOTES) after prostatectomy, we developed a tool to define an uncomplicated recovery after radical nephrectomy (RN) or PN. In this study, we sought to evaluate the impact of comorbidities on peri-operative outcomes based on this tool. METHODS: MUSIC KIDNEY commenced data collection in June 2017. Data abstractors recorded clinical, radiographic, pathologic, and follow-up data for patients with newly diagnosed clinical T1 renal masses (cT1RMs) at 16 MUSIC practices with >90 physicians. Based on the newly developed KIDNEY NOTES tool, a prolonged length of stay (LOS>3 days after MIS, >5 days after open), prolonged warm ischemia time (WIT), extensive estimated blood loss (EBL), positive surgical margin (PSM), or an ED visit/readmission were considered deviations from an otherwise uncomplicated recovery after nephrectomy. Initial management decision and associated perioperative deviations were analyzed based on Charlson Comorbidity Index (CCI). RESULTS: Our study cohort consisted of 1395 patients including 927 patients who underwent PN and 468 who underwent a RN. 58.3%, 19.1% and 22.6% of patients fell into the CCI=0, CCI=1, and CCI >=2 groups. A higher CCI was associated with an increasing likelihood of the patient undergoing a RN (p=0.011) (Fig 1a). The proportion of patients with one or more NOTES deviation was found to be significantly higher with increasing CCI in PN (p=0.01 for PN, p=0.31 for RN, fig 1b). CONCLUSIONS: The lower rate of PN in patients with increased comorbidities could be driven by patients more appropriately being treated on surveillance or RN as our data shows. Based on the NOTES deviations analysis, this is likely appropriate as patients treated with a PN have a higher number of deviations with increasing CCI. Specific comorbidities and factors driving these deviations need further investigation. As comorbidities and life expectancy are clearly an important variable to consider, the MUSIC-KIDNEY group developed a novel life expectancy calculator which is now live to aid treatment decision-making. Source of Funding: Blue Cross Blue Shield of Michigan © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e811 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Mohit Butaney More articles by this author Amit Patel More articles by this author Ji Qi More articles by this author Karandeep Singh More articles by this author Anna Johnson More articles by this author Alison Levy More articles by this author Sabrina Noyes More articles by this author Khurshid Ghani More articles by this author Craig Rogers More articles by this author Brian Lane More articles by this author Expand All Advertisement PDF DownloadLoading ...

Impact of Trifecta definition on rates and predictors of "successful" robotic partial nephrectomy for localized renal masses: results from the Surface-Intermediate-Base Margin Score International Consortium.

Over the years, five different Trifecta score definitions have been proposed to optimize the framing of "success" in partial nephrectomy (PN) field. However, such classifications rely on different metrics. The aim of the present study was to explore how the success rate of robotic PN, as well as its drivers, vary according to the currently available definitions of Trifecta. Data from consecutive patients with cT1-2N0M0 renal masses treated with robotic PN at 16 referral centers from September 2014 to March 2015 were prospectively collected. Trifecta rate was defined for each of the currently available definitions. Multivariable logistic regression analysis was used to evaluate possible predictors of "Trifecta failure" according to the different adopted formulation. Overall, 289 patients met the inclusion criteria. Among the definitions, Trifecta rates ranged between 66.4% and 85.9%. Multivariable analysis showed that predictors for "Trifecta failure" were mainly tumor-related (i.e. tumor's nephrometry) for those Trifecta scores relying on WIT as a surrogate metric for postoperative renal function deterioration (definitions 1,2), while mainly surgery-related (i.e. ischemia time and excision strategy) for those including the percentage change in postoperative eGFR as the functional cornerstone of Trifecta (definitions 3-5). There was large variability in rates and predictors of "unsuccessful PN" when using different Trifecta scores. Further research is needed to improve the value of the Trifecta metrics, integrating them into routine patient counseling and standardized assessment of surgical quality across institutions.

Race/Ethnicity Determines Life Expectancy in Surgically Treated T1aN0M0 Renal Cell Carcinoma Patients

BackgroundLife expectancy (LE) is an important consideration in the clinical decision-making for T1aN0M0 renal cell cancer (RCC) patients. ObjectiveTo test the effect of race/ethnicity (Caucasian, African American, Hispanic/Latino, and Asian) on LE predictions from Social Security Administration (SSA) life tables in male and female T1aN0M0 RCC patients. Design, setting, and participantsWe relied on the Surveillance, Epidemiology, and End Results database. InterventionRadical nephrectomy (RN) and partial nephrectomy (PN). Outcome measurements and statistical analysisFive-year and 10-yr observed overall survival (OS) of pT1aN0M0 RCC patients treated between 2004 and 2006 were compared with the LE predicted from SSA life tables. We repeated the comparison in a more contemporary cohort (2009–2011), with 5-yr follow-up and higher PN rates. Results and limitationsIn the 2004–2006 cohort, PN rate was 40.7%. OS followed the predicted LE in Caucasians, Hispanics/Latinos, and Asians, but not in African Americans, in whom 5-yr OS rates were 5.0% (male) and 8.7% (female) and 10-yr rates were 4.2% (male) and 11.1% (female) lower than predicted. In the 2009–2011 cohort, PN rate was 59.4%. Same observations were made for OS versus predicted LE in Caucasians, Hispanics/Latinos, and Asians. In African Americans, 5-yr OS rates were 1.5% (male) and 4.9% (female) lower than predicted. ConclusionsIn RN- or PN-treated pT1aN0M0 RCC patients, LE predictions closely approximated OS of Caucasians, Hispanics/Latinos, and Asians. In African-American patients, SSA life tables overestimated LE, more in females than in males. The limitations of our study are its retrospective nature, its validity for US patients only, and the under-representation of racial/ethnic minorities. Patient summarySocial Security Administration life tables can be used to estimate long-term life expectancy in patients who are surgically treated for renal cancer (≤4 cm). However, while for Caucasians, Hispanics/Latinos, and Asians, the prediction performs well, life expectancy of African Americans is generally overestimated by life table predictions. Take Home MessageIn the clinical decision-making process for T1aN0M0 renal cell cancer patients eligible for radical or partial nephrectomy, the important influence of patient sex and race/ethnicity on life expectancy should be taken into account, when using Social Security Administration life tables.

Outcomes and predictors of benign histology in patients undergoing robotic partial or radical nephrectomy for renal masses: a multicenter study.

IntroductionTheaim of this study was to assess preoperative factors associated with benign histology in patients undergoing surgical removal of a renal mass and to analyze outcomes of robotic partial nephrectomy (PN) and radical nephrectomy (RN) for these masses.Material and methodsOverall, 2,944 cases (543 benign and 2,401 malignant) who underwent robotic PN and RN between 2003–2018 at 10 institutions worldwide were included. The assessment of the predictors of benign histology was made at the final surgical pathology report. Descriptive statistics, Mann-Whitney U, Pearson’s χ2, and logistic regression analysis were used.ResultsPatients in the benign group were mostly female (61 vs. 33%; p <0.001), with lower body mass index (BMI) (26.0 vs. 27.1 kg/m2; p <0.001). The benign group presented smaller tumor size (2.8 vs. 3.5 cm; p <0.001), R.E.N.A.L. score (6.0 vs. 7.0; p <0.001). There was a lower rate of hilar (11 vs.18%; p = 0.001), cT≥3 (1 vs. 4.5%; p <0.001) tumors in the benign group. There was a statistically significant higher rate of PN in the benign group (97 vs. 86%; p <0.001) as well as a statistically significant lower 30-day re-admission rate (2 vs. 5%; p = 0.081). Multivariable analysis showed male gender (OR: 0.52; p <0.001), BMI (OR: 0.95; p <0.001), and cT3a (OR: 0.22; p = 0.005) to be inversely associated to benign histology.ConclusionsIn 18% of cases, a benign histologic type was found. Only 3% of these tumors were treated with RN. Female gender, lower BMI, and higher T staging showed to be independent predictors of benign histology.

Assessment of local tumor ablation and non-interventional management versus partial nephrectomy in T1a renal cell carcinoma.

Local tumor ablation (LTA) and non-interventional management (NIM) emerged as alternative management options for T1a renal cell carcinoma (RCC). We investigated trends and cancer-specific mortality (CSM) after LTA and NIM, compared to partial nephrectomy (PN). Within the Surveillance, Epidemiology, and End Results database (2004-2015), T1a RCC patients treated with PN, LTA or NIM were identified. Estimated annual proportion change methodology (EAPC), 1:1 ratio propensity score (PS) matching, cumulative incidence plots and multivariable competing risks regression models (CRR) were used to compare LTA vs. PN and NIM vs. PN. Subgroup analyses focused on patients <65 and ≥65 years. Overall 4524 patients underwent LTA vs. 1654 NIM vs. 25,435 PN. Annuals rates increased for NIM (EAPC: +3.3%, P<0.001), but not for either LTA or PN. After PS-matching in multivariable CCR, LTA (HR 1.9, P<0.001) and NIM (HR 3.0, P<0.001) showed worse 5-year CSM, relative to PN. In subgroup analyses, LTA showed no CSM disadvantage relative to PN in younger patients (HR 2.0, P=0.07). In older patients 1.64-fold CSM increase was recorded. Conversely, NIM younger (HR 3.1, P=0.001) and older (HR 3.1, P<0.001) patients exhibited higher CSM relative to PN. In T1a RCC patients, NIM rates showed a modest but significant increase, while LTA and PN rates remained stable. In survival analyses, LTA exhibited higher CSM rates only for elderly patients. Conversely, NIM exhibited higher CSM rates in both younger and older patients.

Guideline adherence for the surgical treatment of T1 renal tumours correlates with hospital volume: an analysis from the British Association of Urological Surgeons Nephrectomy Audit.

To assess European Association of Urology guideline adherence on the surgical management of patients with T1 renal tumours and the effects of centralisation of care. Retrospective data from all kidney tumours that underwent radical nephrectomy (RN) or partial nephrectomy (PN) in the period 2012-2016 from the British Association of Urological Surgeons Nephrectomy Audit were retrieved and analysed. We assessed total surgical hospital volume (HV; RN and PN performed) per centre, PN rates, complication rates, and completeness of data. Descriptive analyses were performed, and confidence intervals were used to illustrate the association between hospital volume and proportion of PN. Chi- squared and Cochran-Armitage trend tests were used to evaluate differences and trends. In total, 13045 surgically treated T1 tumours were included in the analyses. Over time, there was an increase in PN use (39.7% in 2012 to 44.9% in 2016). Registration of the Preoperative Aspects and Dimensions Used for an Anatomical (PADUA) complexity score was included in March 2016 and documented in 39% of cases. Missing information on postoperative complications appeared constant over the years (8.5-9%). A clear association was found between annual HV and the proportion of T1 tumours treated with PN rather than RN (from 18.1% in centres performing <25 cases/year [lowest volume] to 61.8% in centres performing ≥100 cases/year [high volume]), which persisted after adjustment for PADUA complexity. Overall and major (Clavien-Dindo grade≥III) complication rate decreased with increasing HV (from 12.2% and 2.9% in low-volume centres to 10.7% and 2.2% in high-volume centres, respectively), for all patients including those treated with PN. Closer guideline adherence was exhibited by higher surgical volume centres. Treatment of T1 tumours using PN increased with increasing HV, and was accompanied by an inverse association of HV with complication rate. These results support the centralisation of kidney cancer specialist cancer surgical services to improve patient outcomes.

Partial and radical nephrectomy in children, adolescents, and young adults: Equivalent readmissions and postoperative complications

ObjectivesTo compare and contrast the use of partial nephrectomy (PN) and radical nephrectomy (RN) in pediatric malignant renal tumors using a nationally representative database. MethodsThe 2010–2014 Nationwide Readmissions Database (NRD) was used to obtain PN and RN select postoperative data. ICD-9-CM codes were used to identify children (<10 years), adolescents (10–19 years) and young adults (20–30 years) diagnosed with malignant renal tumors who were treated with a PN or RN. The presence of a 30-day readmission, occurrence of postoperative complications, cost, and length of stay (LOS) were studied and weighted logistic regression models were fit to test for associations. ResultsThere were 4330 weighted encounters (1289 PNs, 3041 RNs) that met inclusion criteria: 50.8% were children, 7.2% were adolescents, and 42% were young adults. Young adults had the highest rates of PN, whereas children had the highest rates of RN (p < 0.0001). Overall, no evidence was found to suggest a difference in odds between surgical modality and the presence of a 30-day readmission or postoperative complication. While PN was on average $9000 cheaper compared to RN overall, its cost was similar to that of RN for children. Similarly, PN patients had a shorter overall LOS compared to RN patients, but their LOS was similar to that of children who underwent RN. ConclusionThere was no evidence of a difference in odds between RN and PN in terms of postoperative readmissions or in-hospital complication rates. Additionally, we observed descriptive differences in both cost and LOS between the surgical modalities across age groups. Type of studyRetrospective comparative study (administrative database analysis). Level of evidenceLevel III.

National Norwegian Practice Patterns for Surgical Treatment of Kidney Cancer Tumors ≤7 cm: Adherence to Changes in Guidelines May Improve Overall Survival

BackgroundGuidelines on surgical treatment for kidney cancer (KC) have changed over the last 10 yr. We present population-based data for patients with KC tumors ≤7cm from 2008 to 2013 to investigate whether surgical practice in Norway has changed according to guidelines. ObjectiveTo assess the predictors of treatment and survival after KC surgery. Design, setting, and participantsWe identified all surgically treated KC patients with tumors ≤7cm without metastasis diagnosed during 2008–2013 (2420 patients) from the Cancer Registry of Norway. Outcome measurements and statistical analysisRelationships with outcomes were analyzed using joinpoint regression, multivariate logistic regression, Kaplan-Meier survival estimates, Cox regression, relative survival (RS), and competing-risk analyses. Results and limitationsThe mean follow-up was 5.2 yr. There was a 28% increase in the number of patients undergoing surgical treatment over the study period. Joinpoint regression revealed a significant annual increase in partial nephrectomy (PN) and a small reduction in radical nephrectomy (RN). PN increased from 43% to 66% for tumors ≤4cm and from 10% to 18% for tumors of 4.1–7cm. Minimally invasive (MI) RN increased from 53% to 72% and MI PN from 25% to 64%, of which 55% of procedures were performed with robotic assistance in 2013. The geographical distribution of treatment approaches differed significantly. Both PN and MI approaches were more frequent in high-volume hospitals. Cox regression analysis revealed that PN, age, and Fuhrman grade and stage were independent predictors of survival. There were no significant differences in cancer-specific survival (p=0.8). The 5-yr RS for T1a disease was higher after PN than after RN. ConclusionsThe rate of PN for tumors ≤7cm increased in the 6-yr study period. MI approaches increased for both RN and PN. This treatment shift coincides with the new guideline recommendations in 2010. The possible better survival for patients undergoing PN compared to RN indicates the importance of following evidence-based guidelines. Patient summaryThe use of partial nephrectomy and minimally invasive surgery for kidney cancer tumors increased in Norway from 2008 to 2013 according to population-based data, coinciding with guideline changes. The study illustrate that adherence to guidelines may improve patient outcomes.

MP69-15 RECEIPT OF MANNITOL USE IN PARTIAL NEPHRECTOMY AND RATES OF CONVERSION TO RADICAL NEPHRECTOMY AFTER MANNITOL ADMINISTRATION

You have accessJournal of UrologyGeneral & Epidemiological Trends & Socioeconomics: Practice Patterns, Quality of Life and Shared Decision Making III1 Apr 2017MP69-15 RECEIPT OF MANNITOL USE IN PARTIAL NEPHRECTOMY AND RATES OF CONVERSION TO RADICAL NEPHRECTOMY AFTER MANNITOL ADMINISTRATION Yash Khandwala, In Gab Jeong, Ye Wang, Deok Hyun Han, Jae Heon Kim, Shufeng Li, Steven L Chang, and Benjamin Chung Yash KhandwalaYash Khandwala More articles by this author , In Gab JeongIn Gab Jeong More articles by this author , Ye WangYe Wang More articles by this author , Deok Hyun HanDeok Hyun Han More articles by this author , Jae Heon KimJae Heon Kim More articles by this author , Shufeng LiShufeng Li More articles by this author , Steven L ChangSteven L Chang More articles by this author , and Benjamin ChungBenjamin Chung More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2017.02.2311AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Accurate rates of mannitol use for partial nephrectomy (PN) and subsequent intra-operative conversion from PN to radical nephrectomy (RN) are unknown. Understanding factors predictive for conversion and ascertaining surgical outcomes of these converted nephrectomies would contribute greatly to the literature and also allow clinicians to better counsel prospective patients. Thus, we sought to calculate conversion rates of both open and minimally invasive PN using mannitol usage as an indicator for PN intent and to identify factors associated with the conversion from PN to RN. METHODS A total of 136,298 patients undergoing PN (open: n=68,580, laparoscopic: n=17,549, robotic: n=50,169) and 423,759 undergoing RN (open: n=237,411, laparoscopic: n=143,179, robotic: n=43,169) were identified from the Premier Perspective Database, an all-payer hospital clinical and economic database in the U.S. capturing patients from 2003 to 2015. An algorithm utilizing a variety of charge and billing codes based on the use of mannitol osmotic diuretic in RN was used to calculate rates of conversion. RESULTS Overall, mannitol was used in 41.7% of the total PN cohort (open: 32.4%, laparoscopic: 21.7%, robotic: 59.9%, p <0.001). After adjusting for the use of mannitol, the conversion rate of PN to RN was 27.9% for open, 42.6% for laparoscopic, and 14.2% for the robotic approach (p <0.001). Multivariate analysis found that age, gender, charlson comorbidity index, surgical approach, surgery year, and annual surgeon and hospital volume were independent factors associated with conversion from PN to RN (all p<0.001). After adjusting for patient, surgeon and hospital demographics, laparoscopic approach had higher odds (OR=1.77, 95% CI 1.5 to 2.2, p=<0.001) and the robotic-approach had lower odds (OR=0.62, 95% CI 0.54-0.71, p<0.001) of conversion compared to open surgery. CONCLUSIONS Robot-assisted PN had higher usage rates of mannitol compared to laparoscopic and open approaches. Also, robotic PN had the lowest odds of PN to RN conversion while the laparoscopic approach had the highest odds of conversion. Clinicians should be aware of these conversion rates especially prior to undertaking technically difficult nephron sparing procedures irrespective of approach. © 2017FiguresReferencesRelatedDetails Volume 197Issue 4SApril 2017Page: e932 Advertisement Copyright & Permissions© 2017MetricsAuthor Information Yash Khandwala More articles by this author In Gab Jeong More articles by this author Ye Wang More articles by this author Deok Hyun Han More articles by this author Jae Heon Kim More articles by this author Shufeng Li More articles by this author Steven L Chang More articles by this author Benjamin Chung More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Geographic variation in the adoption rate of partial nephrectomy over radical nephrectomy for the treatment of malignant renal neoplasm.

e13066Background: Studies have shown that an increasingly greater proportion of renal malignancy cases are now being treated by partial nephrectomy (PN) rather than radical nephrectomy (RN). This study observed the adoption rate of PN over RN in different health service areas (HSAs) for the treatment of malignant neoplasm of the kidney, over the past 31 years in New York State (NYS). Methods: The study was a retrospective cohort study of 50,953 cases between 1982-2012, from the Statewide Planning And Research Cooperative System database. Patient records matching the diagnosis of malignant renal neoplasm (ICD9:18.90) were extracted and separated by surgical procedure, RN (ICD9 55.5, N = 39,318) and PN (ICD9 55.4, N = 11,365). The records were organized based on the facility zip code and grouped into 8 individual HSAs. The compound annual growth rate (CAGR) was calculated for the number of PN and RN procedures occurring in each of the HSAs between 1982-2012. The total ancillary charges were compared for all...

Partial Nephrectomy for Small Renal Masses: Do Teaching and Nonteaching Institutions Adhere to Guidelines Equally?

The American Urological Association (AUA) guidelines recommend partial nephrectomy (PN) as the gold standard for treatment of small renal masses (SRMs). This study examines the change in utilization of partial and radical nephrectomies at teaching and nonteaching institutions from 2003 to 2012. The data sample for this study came from the Healthcare Cost and Utilization Project Nationwide Inpatient Sample from 2003 to 2012. International Classification of Diseases, Ninth Revision and Clinical Modification codes were used to identify patients undergoing PN and radical nephrectomy for renal masses limited to the renal parenchyma. Teaching hospitals were defined, but not limited to any institution with an American Medical Association-approved residency program. Linear regression, bivariate, multivariate, and odds ratio analysis were used to demonstrate statistical significance. 39,685 patients were identified in teaching hospitals, and 22,239 were identified in nonteaching hospitals. Prior to the 2009 AUA guidelines, cumulative rates of PN were 33% vs 20% in teaching vs nonteaching hospitals (p < 0.0001) compared with postguideline rates of 48% vs 33% in teaching vs nonteaching hospitals (p < 0.0001). During the 10-year study period, the use of PN to treat SRMs has significantly increased in both teaching hospitals and in nonacademic centers; however, these changes are occurring at a slower rate in nonteaching hospitals.

MP59-19 POPULATION-BASED ASSESSMENT OF TREATMENT MODALITIES IN THE ELDERLY WITH LOCALIZED RENAL CELL CARCINOMA: THE 2000–2009 UPDATE

You have accessJournal of UrologyKidney Cancer: Surgical Therapy III1 Apr 2015MP59-19 POPULATION-BASED ASSESSMENT OF TREATMENT MODALITIES IN THE ELDERLY WITH LOCALIZED RENAL CELL CARCINOMA: THE 2000–2009 UPDATE Maxine Sun, Alessandro Larcher, Michael McCormarck, Shahrokh Shariat, Luc Valiquette, Fred Saad, and Pierre Karakiewicz Maxine SunMaxine Sun More articles by this author , Alessandro LarcherAlessandro Larcher More articles by this author , Michael McCormarckMichael McCormarck More articles by this author , Shahrokh ShariatShahrokh Shariat More articles by this author , Luc ValiquetteLuc Valiquette More articles by this author , Fred SaadFred Saad More articles by this author , and Pierre KarakiewiczPierre Karakiewicz More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2015.02.2179AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Treatment management of localized renal cell carcinoma (RCC) has undergone significant changes over time. Our objective was to characterize the treatment patterns of patients diagnosed with localized RCC in a contemporary population-based cohort of the US. METHODS Using the Surveillance, Epidemiology, and End Results (SEER) Medicare-linked database, patients diagnosed with T1 RCC between years 2000 and 2009 were identified. Treatment modalities were defined as nephrectomy, local tumor destruction (LTD), or observation. Surgically-managed patients were further subdivided into radical nephrectomy (RN) and partial nephrectomy (PN). Those who underwent a laparoscopic or robotic-assisted nephrectomy were grouped under the minimally-invasive approach. Finally patient and disease characteristics were evaluated in multivariable logistic regression analyses for prediction of treatment type. All analyses were repeated in patients with T1a RCC. RESULTS Overall 9350 patients with T1 RCC were identified. Between 2000 and 2009, nephrectomy rates decreased from 88 to 71% (–1.6%/year, P<0.001), LTD rates increased from 0 to 15% (+1.4%/year, P<0.001), and observation rates remained stable from 13 to 15% (+0.2%/year, P=0.063). Amongst surgically-managed patients, open RN rates decreased overtime from 86 to 60% (–2.2%/year, P<0.001) while open PN rates increased from 15 to 40% (+2.5%/year, P<0.001). However, both minimally-invasive RN (from 4 to 37%, +3.9%/year, P<0.001) and PN rates (from 0 to 19%, +2.0%/year, P<0.001) increased over time. Similar trends were observed when analyses were restricted to those with T1a RCC only. Notable disparities were noted according to treatment type and gender, socioeconomic status, and race. CONCLUSIONS During the study span, lower rates of surgical treatment were observed, whereas LTD rates increased over time. In surgically-managed patients, the rates of PN increased significantly. Increases in minimally-invasive RN were also observed. © 2015 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 193Issue 4SApril 2015Page: e737 Peer Review Report Advertisement Copyright & Permissions© 2015 by American Urological Association Education and Research, Inc.MetricsAuthor Information Maxine Sun More articles by this author Alessandro Larcher More articles by this author Michael McCormarck More articles by this author Shahrokh Shariat More articles by this author Luc Valiquette More articles by this author Fred Saad More articles by this author Pierre Karakiewicz More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

102 Population-based assessment of treatment modalities in the elderly with localized renal cell carcinoma: The 2000–2009 update

INTRODUCTION AND OBJECTIVES: Treatment management of localized renal cell carcinoma (RCC) has undergone significant changes over time. Our objective was to characterize the treatment patterns of patients diagnosed with localized RCC in a contemporary population-based cohort of the US. METHODS: Using the Surveillance, Epidemiology, and End Results (SEER) Medicare-linked database, patients diagnosed with T1 RCC between years 2000 and 2009 were identified. Treatment modalities were defined as nephrectomy, local tumor destruction (LTD), or observation. Surgically-managed patients were further subdivided into radical nephrectomy (RN) and partial nephrectomy (PN). Those who underwent a laparoscopic or robotic-assisted nephrectomy were grouped under the minimally-invasive approach. Finally patient and disease characteristics were evaluated in multivariable logistic regression analyses for prediction of treatment type. All analyses were repeated in patients with T1a RCC. RESULTS: Overall 9350 patients with T1 RCC were identified. Between 2000 and 2009, nephrectomy rates decreased from 88 to 71% (e1.6%/year, P<0.001), LTD rates increased from 0 to 15% (þ1.4%/year, P<0.001), and observation rates remained stable from 13 to 15% (þ0.2%/year, P1⁄40.063). Amongst surgically-managed patients, open RN rates decreased overtime from 86 to 60% (e2.2%/year, P<0.001) while open PN rates increased from 15 to 40% (þ2.5%/year, P<0.001). However, both minimally-invasive RN (from 4 to 37%, þ3.9%/year, P<0.001) and PN rates (from 0 to 19%, þ2.0%/year, P<0.001) increased over time. Similar trends were observed when analyses were restricted to those with T1a RCC only. Notable disparities were noted according to treatment type and gender, socioeconomic status, and race. CONCLUSIONS: During the study span, lower rates of surgical treatment were observed, whereas LTD rates increased over time. In surgically-managed patients, the rates of PN increased significantly. Increases in minimally-invasive RN were also observed.

Evaluation of national trends in the utilization of partial nephrectomy in relation to the publication of the American Urologic Association guidelines for the management of clinical T1 renal masses.

BackgroundPartial nephrectomy has been underutilized in the United States. We investigated national trends in partial nephrectomy (PN) utilization before and after publication of the American Urological Association (AUA) Practice Guideline for management of the clinical T1 renal mass.MethodsWe identified adult patients who underwent radical (RN) or PN from November 2007 to October 2011 in the Nationwide Inpatient Sample (NIS). PN prevalence was calculated prior to (11/2007-10/2009) and after Guidelines publication (11/2009-10/2011) and compared the rate of change by linear regression. We also examined the nephrectomy trends in patients with chronic kidney disease (CKD). Statistical analysis included linear regression to determine point-prevalence of PN rates in CKD patients and logistic regression to identify variables associated with PN.ResultsDuring the study period, 30,944 patients underwent PN and 64,767 RN. The prevalence PN increased from 28.9% in the years prior to guideline release to 35.3% in the years following guideline release with an adjusted odds ratio (OR) of 1.24 (CI 1.01–1.54; p = 0.049). The rate of PN significantly increased throughout the study period (R2 0.15, p = 0.006): however, the rate of change was not increased after the guidelines. (p = 0.46). Overall rate of PN in patients with CKD did not increase over time (R2 0.0007, p = 0.99).ConclusionWe noted a 6.4% absolute increase in PN after release of the AUA guidelines on clinical T1 renal mass was published; however, the rate of increase was not likely associated with guideline release. The rate of PN performed is increasing; however, further investigation regarding medical decision-making surrounding PN is needed.

Radiofrequency ablation versus partial nephrectomy for the treatment of clinical stage 1 renal masses: a systematic review and meta-analysis

Background Over the past two decades, the clinical presentation of renal masses has evolved, where the rising incidence of small renal masses (SRMs) and concomitant minimal invasive treatments have led to noteworthy changes in paradigm of kidney cancer. This study was to perform a proportional meta-analysis of observational studies on perioperative complications and oncological outcomes of partial nephrectomy (PN) and radiofrequency ablation (RFA). Methods The US National Library of Medicine’s life science database (Medline) and the Web of Science were exhaustly searched before August 1, 2013. Clinical stage 1 SRMs that were treated with PN or RFA were included, and perioperative complications and oncological outcomes of a total of 9 565 patients were analyzed. Results Patients who underwent RFA were significantly older (P &lt;0.001). In the subanalysis of stage T1 tumors, the major complication rate of PN was greater than that of RFA (laparoscopic partial nephrectomy (LPN)/robotic partial nephrectomy (RPN): 7.2%, open partial nephrectomy (OPN): 7.9%, RFA: 3.1%, both P &lt;0.001). Minor complications occurred more frequently after RFA (RFA: 13.8%, LPN/RPN: 7.5%, OPN: 9.5%, both P &lt;0.001). By multivariate analysis, the relative risks for minor complications of RFA, compared with LPN and OPN, were 1.7-fold and 1.5-fold greater (both P &lt;0.01), respectively. Patients treated with RFA had a greater local progression rate than those treated by PN (RFA: 4.6%, LPN/RPN: 1.2%, OPN: 1.9%, both P &lt;0.001). By multivariate analysis, the local tumor progression for RFA versus LPN/RPN and OPN were 4.5-fold and 3.1-fold greater, respectively (both P &lt;0.001). Conclusions The current data illustrate that both PN and RFA are viable strategies for the treatment of SRMs. Compared with PN, RFA showed a greater risk of local tumor progression but a lower major complication rate, which is considered better for poor candidates. PN is with no doubt the golden treatment for SRMs, and LPN has been widely accepted as the first option for nephron-sparing surgery by experienced urologists. RFA may be the best option for select patients with significant comorbidity.