title: Partial nephrectomy versus ablative therapy for the treatment of renal tumors in an imperative setting.
abstract: OBJECTIVE
  To compare partial nephrectomy (PN) and percutaneous ablative therapy (AT) for renal tumor in imperative indication of nephron-sparing technique (NST).
  
  
  METHODS
  Between 2000 and 2015, 284 consecutive patients with a kidney tumor in an imperative indication of NST were retrospectively included in a multicenter study. PN [open (n = 146), laparoscopic (n = 9), or robotic approach (n = 17)] and AT [radiofrequency ablation (n = 104) or cryoablation (n = 8)] were performed for solitary kidney (n = 146), bilateral tumor (n = 78), or chronic kidney disease (CKD) (n = 60).
  
  
  RESULTS
  Patients in the PN group had larger tumors and a higher RENAL score. There were no differences between the two groups with respect to age, reasons for imperative indication, and preoperative eGFR. Patients in the AT group had a higher ASA and CCI. PN had worse outcomes than AT in terms of transfusion rate, length of stay, and complication rate. Local radiological recurrence-free survival was better for PN, but metastatic recurrence was similar. Percentage of eGFR decrease was similar in the two groups. Temporary or permanent dialysis was not significantly different. On multivariate analysis, PN and AT had a similar eGFR change when adjusted for tumor complexity, reason of imperative indication and CCI.
  
  
  CONCLUSIONS
  In imperative indication of nephron-sparing treatment for a kidney tumor, either PN or AT can be proposed. PN offers the ability to manage larger and more complex tumors while providing a better local control and a similar renal function loss.
authors: Urology Department, Grenoble University Hospital, 38043, Grenoble, France. JALong@chu-grenoble.fr.|TIMC-IMAG Laboratory, UMR CNRS 5525, Grenoble, France. JALong@chu-grenoble.fr.
authors: Jean-Alexandre
authors: JA
authors: Long
authors: Urology Department, Bordeaux University Hospital, Bordeaux, France.
authors: Jean-Christophe
authors: JC
authors: Bernhard
authors: Urology Department, Angers University Hospital, Angers, France.
authors: Pierre
authors: P
authors: Bigot
authors: Urology Department, Grenoble University Hospital, 38043, Grenoble, France.
authors: Cecilia
authors: C
authors: Lanchon
authors: Urology Department, Lyon-Sud University Hospital, Pierre-Bénite, France.
authors: Philippe
authors: P
authors: Paparel
authors: Pathology Department, Rennes University Hospital, Rennes, France.
authors: Nathalie
authors: N
authors: Rioux-Leclercq
authors: Oncology Department, Gustave Roussy Institute, Paris, France.
authors: Laurence
authors: L
authors: Albiges
authors: Prado-Louvain Urology Center, Marseille, France.
authors: Thomas
authors: T
authors: Bodin
authors: Urology Department, Rouen University Hospital, Rouen, France.
authors: François-Xavier
authors: FX
authors: Nouhaud
authors: Urology Department, La Conception University Hospital, Marseille, France.
authors: Romain
authors: R
authors: Boissier
authors: Urology Department, Medipole, Cabestany, France.
authors: Pierre
authors: P
authors: Gimel
authors: Urology Department, Georges Pompidou University Hospital, Paris, France.
authors: Arnaud
authors: A
authors: Méjean
authors: Urology Department, Mondor University Hospital, Creteil, France.
authors: Alexandra
authors: A
authors: Masson-Lecomte
authors: Radiology Department, Bordeaux University Hospital, Pessac, France.
authors: Nicolas
authors: N
authors: Grenier
authors: Radiology Department, Bordeaux University Hospital, Pessac, France.
authors: Francois
authors: F
authors: Cornelis
authors: Urology Department, Bordeaux University Hospital, Bordeaux, France.
authors: Yohann
authors: Y
authors: Grassano
authors: Urology Department, Bordeaux University Hospital, Bordeaux, France.
authors: Vincent
authors: V
authors: Comat
authors: Urology Department, Nantes University Hospital, Nantes, France.
authors: Quentin Come
authors: QC
authors: Le Clerc
authors: Urology Department, Nantes University Hospital, Nantes, France.
authors: Jérome
authors: J
authors: Rigaud
authors: Urology Department, Mondor University Hospital, Creteil, France.
authors: Laurent
authors: L
authors: Salomon
authors: Urology Department, Grenoble University Hospital, 38043, Grenoble, France.
authors: Jean-Luc
authors: JL
authors: Descotes
authors: Radiology Department, Grenoble University Hospital, La Tronche, France.
authors: Christian
authors: C
authors: Sengel
authors: Urology Department, La Pitie-Salpetriere University Hospital, Paris, France.
authors: Morgan
authors: M
authors: Roupret
authors: Urology Department, Rennes University Hospital, Rennes, France.
authors: Gregory
authors: G
authors: Verhoest
authors: Urology Department, Bichat University Hospital, Paris, France.
authors: Idir
authors: I
authors: Ouzaid
authors: Urology Department, Annecy-Genevois Hospital, Metz-Tessy, France.
authors: Valentin
authors: V
authors: Arnoux
authors: Urology Department, Rennes University Hospital, Rennes, France.
authors: Karim
authors: K
authors: Bensalah
mesh_terms: D055011:Ablation Techniques / Q000379:methods*; D000368:Aged; D001803:Blood Transfusion / Q000706:statistics & numerical data; D002292:Carcinoma, Renal Cell / Q000453:epidemiology / Q000601:surgery*; D017115:Catheter Ablation / Q000379:methods; D015897:Comorbidity; D000013:Congenital Abnormalities / Q000453:epidemiology; D003452:Cryosurgery / Q000379:methods; D018572:Disease-Free Survival; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D007668:Kidney / Q000002:abnormalities; D007674:Kidney Diseases / Q000151:congenital / Q000453:epidemiology; D007680:Kidney Neoplasms / Q000453:epidemiology / Q000601:surgery*; D010535:Laparoscopy; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009378:Neoplasms, Multiple Primary / Q000601:surgery*; D009392:Nephrectomy / Q000379:methods*; D009399:Nephrons; D059351:Organ Sparing Treatments; D011183:Postoperative Complications / Q000453:epidemiology; D051436:Renal Insufficiency, Chronic / Q000453:epidemiology; D012189:Retrospective Studies; D065287:Robotic Surgical Procedures; D016896:Treatment Outcome; D047368:Tumor Burden
keywords: Cryoablation; Imperative indication; Partial nephrectomy; Radiofrequency; Renal cancer