Page 15 - Read Online

Pecoraro et al. Mini-invasive Surg 2024;8:29 https://dx.doi.org/10.20517/2574-1225.2023.90 Page 5 of 11

Both approaches appear to have acceptable rates of perioperative complications and effects on renal
function [28,29] .

Concerning RFA, Zhang et al. focused on nine patients treated with bilateral RFA through different
[29]
approaches . During the mean 33 months of follow-up, local tumor control rate was 93.1%, and both the
cancer-specific and the overall survival rate were 100%.

Regarding functional outcomes, no statistically meaningful decline in renal function was observed between
postoperative and preoperative levels (93.7 ± 13.0 mL/min/1.73 m vs. 96.9 ± 13.3 mL/min/1.73 m ,
2
2
respectively; P > 0.05).
Regarding CA, Mason et al. compared percutaneous CA (n = 13), under either CT or ultrasound (US)
guidance, with partial nephrectomy (n = 75 underwent open approach and n = 1 underwent laparoscopic
approach) in terms of functional and perioperative outcomes .
[28]
They found that the median change in estimated glomerular filtration rate (eGFR) from preoperative to the
time of discharge was -32% [interquartile range (IQR) -46, -15] for partial nephrectomy (PN) patients and
-17% (IQR -33, -3) for percutaneous cryoablation (PCA) patients. After three months, median renal
function improved, with changes of -9% (IQR -19, 0) and -8% (IQR -11, 15), respectively, compared with
baseline. Thirty-day postoperative complications occurred in 16 (21.6%) PN patients and four (30.7%) PCA
patients. This suggests that percutaneous CA has acceptable rates of perioperative complications and effects
on renal function.

SURGICAL TREATMENT
In contrast to hereditary disease, where tumor growth is fast, and SRM is usually managed with AS and
multiple minimally invasive ablative procedures, bilateral sporadic SRM can be managed by a single
minimally (both laparoscopic or robot assisted) NSS with acceptable morbidity [35-40] .

The robotic surgery for large renal mass (ROSULA) collaborative group highlighted the importance of
[41]
performing NSS in these patients compared to radical surgical treatment .

Patients undergoing PN exhibited significantly better preservation of eGFR compared to those
[41]
undergoing radical nephrectomy (RN). The study concluded that, despite the complexity of the tumor, PN
should be prioritized when feasible due to its renal function preservation benefits, especially in patients at
risk for long-term renal insufficiency. For bilateral masses, this is particularly relevant, as bilateral RN would
almost certainly lead to dialysis dependency, while PN allows for partial preservation of kidney function in
both kidneys.

Focusing on the oncological outcomes and perioperative complications associated with PN vs. RN in
[42]
treating complex renal masses, both PN and RN provided excellent oncological control, with no significant
difference in cancer-specific survival or recurrence rates between the two approaches, even in cases of large
or complex tumors. However, the complication rates were slightly higher in PN due to the technical
complexity of preserving renal tissue, particularly for hilar or endophytic tumors. Despite this, the overall
morbidity associated with PN was acceptable. These findings support current guidelines .
[8,9]