INTRODUCTION AND OBJECTIVE: Open and minimally invasive (MI; laparoscopic or robotic-assisted) surgical techniques are applied to treat renal cell carcinoma (RCC), and their oncological equivalence has been always questionned. This study aimed to compare prognosis and survival outcomes between open and MI techniques in patients undergoing curative surgery for non-metastatic papillary RCC (papRCC). METHODS: This multi-institutional study was conducted by the EAU-YAU Renal Cancer Working Group. A total of 2076 patients undergoing curative surgery for non-metastatic papRCC were collected for the dataset. After exclusion of 380 patients due to incomplete records or loss-to-follow-up, a total of 1696 patients were included into this study. Furthermore, a subgroup of 490 patients was defined by matching 245 patients from each operative technique at 1:1 ratio, in terms of year of surgery, age, nephrectomy type (partial/radical) and clinical tumor stage. The retrospectively collected demographical, clinical, histopathological and oncological data were compared between open and MI techniques in the overall and matched-pair cohorts. Chi-square and Mann-Whitney U tests, and Kaplan-Meier analysis were used for the statistical analyses. RESULTS: In overall, patients who underwent open surgery were more frequently male, with symptomatic disease, had a higher rate of radical nephrectomy, and presented with greater clinical and pathological T stages, tumor sizes, pathologic N1 stage, VENUSS score and risk group, and tumors with necrosis and sarcomatoid dedifferentiation. Follow-up was significantly longer in the open group, and disease free-(DFS), cancer specific-(CSS) and overall survival (OS) were significantly worse. In matched-pair comparison, symptomatic disease, pathologic N1 stage, sarcomatoid differentiation and type 2 papRCC were significantly higher in the open group. During similar follow-up duration (48 vs. 49 months, p=0.925), DFS and CSS were similar between two techniques while OS (p=0.042) was lower in the open group. CONCLUSIONS: In this multi-institutional study, open technique was associated with adverse outcomes and worse prognosis after curative surgery for non-metastatic papRCC in unbalanced overall cohort. However, although some adverse outcomes remained, there were no significant differences between the two techniques in terms of cancer-specific prognosis in a balanced matched-pair cohort.
DO OPEN AND MINIMALLY INVASIVE TECHNIQUES AFFECT PROGNOSIS AND SURVIVAL OUTCOMES IN PATIENTS UNDERGOING CURATIVE SURGERY FOR NON-METASTATIC PAPILLARY RENAL CELL CARCINOMA? COMPARATIVE ANALYSIS OF A MATCHED-PAIR COHORT FROM A MULTI-INSTITUTIONAL DATABASE
Bertolo, R;
2023-01-01
Abstract
INTRODUCTION AND OBJECTIVE: Open and minimally invasive (MI; laparoscopic or robotic-assisted) surgical techniques are applied to treat renal cell carcinoma (RCC), and their oncological equivalence has been always questionned. This study aimed to compare prognosis and survival outcomes between open and MI techniques in patients undergoing curative surgery for non-metastatic papillary RCC (papRCC). METHODS: This multi-institutional study was conducted by the EAU-YAU Renal Cancer Working Group. A total of 2076 patients undergoing curative surgery for non-metastatic papRCC were collected for the dataset. After exclusion of 380 patients due to incomplete records or loss-to-follow-up, a total of 1696 patients were included into this study. Furthermore, a subgroup of 490 patients was defined by matching 245 patients from each operative technique at 1:1 ratio, in terms of year of surgery, age, nephrectomy type (partial/radical) and clinical tumor stage. The retrospectively collected demographical, clinical, histopathological and oncological data were compared between open and MI techniques in the overall and matched-pair cohorts. Chi-square and Mann-Whitney U tests, and Kaplan-Meier analysis were used for the statistical analyses. RESULTS: In overall, patients who underwent open surgery were more frequently male, with symptomatic disease, had a higher rate of radical nephrectomy, and presented with greater clinical and pathological T stages, tumor sizes, pathologic N1 stage, VENUSS score and risk group, and tumors with necrosis and sarcomatoid dedifferentiation. Follow-up was significantly longer in the open group, and disease free-(DFS), cancer specific-(CSS) and overall survival (OS) were significantly worse. In matched-pair comparison, symptomatic disease, pathologic N1 stage, sarcomatoid differentiation and type 2 papRCC were significantly higher in the open group. During similar follow-up duration (48 vs. 49 months, p=0.925), DFS and CSS were similar between two techniques while OS (p=0.042) was lower in the open group. CONCLUSIONS: In this multi-institutional study, open technique was associated with adverse outcomes and worse prognosis after curative surgery for non-metastatic papRCC in unbalanced overall cohort. However, although some adverse outcomes remained, there were no significant differences between the two techniques in terms of cancer-specific prognosis in a balanced matched-pair cohort.
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