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

Table 1. Surgical vs. non-surgical treatment: oncological and functional outcomes
Survival Recurrence
Study Treatment type Sample size and FU Complications
rates rates
Sheikh et al., AS 70, 72 months 5-year OS 4% 15% (major complications)
2018 [12] 100%
5-years CSS
95%
MFS 100%
Mason et al., Bilateral PN or PCA, FU not 76 PN and 13 PCA NR NR 20% (mostly minor)
2018 [28] reported
Zhang et al., RFA and open RN 3 one-stage RN and RFA 5-year CSM NR 33% (only minor)
2018 [29] and 9 one-stage RFA, 33 100%
months 5-year OS
100%
Hillyer et al., One-stage RAPN vs. two-stage 18 RAPN vs. 32 LPN, 7.5 NR NR 11% RAPN vs. 12.5% LPN (2 patients
2011 [36] LPN months with major complication in LPN
group)
Di Maida One vs. two-stage OPN or RAPN 41 patients, 42 months DFS 90.2% Local 2.4% CD II 7.3%
[40]
et al., 2022 or RN CSM 7.3% Systemic 7.3% CD III 4.9%
Lowrance One-stage OPN, one-stage 73 patients, of those 32 5-year OS 13% 15% (major complications)
[52]
et al., 2010 ORN, RN followed by PN, PN one-stage OPN, 38 85%
followed by RN months
FU: Follow up; AS: active surveillance; OS: overall survival; CSS: cancer specific survival; MFS: metastases free survival; PN: partial nephrectomy;
PCA: percutaneous cryoablation; NR: not reported; RFA: radiofrequency ablation; RN: radical nephrectomy; CSM: cancer specific survival; RAPN:
robot assisted partial nephrectomy; LPN: laparoscopic partial nephrectomy; OPN: open partial nephrectomy, DFS: disease free survival; CD:
clavine Dindo; ORN: open radical nephrectomy.

RFA achieves excellent local tumor control while minimizing effects on renal function, with cancer-specific
and overall survival rates similar to surgical treatments.

CA yields comparable oncological outcomes to RFA, with a slight advantage in preserving renal function
when compared to partial nephrectomy.

A two-step bilateral PN also offers high oncological control but better preserves renal function than
simultaneous surgery, particularly for patients at higher risk of AKI.

CONCLUSIONS
Current guidelines from both the EAU and AUA emphasize the importance of a nephron-sparing approach
for BSRM, with PN being the preferred treatment when feasible. AS and AT are valuable alternatives,
particularly for patients with small tumors or significant comorbidities. The decision between simultaneous
and staged surgery should be individualized based on patient-specific factors, with the aim of maximizing
oncological control while preserving renal function. Emerging imaging modalities and genetic profiling are
expected to further refine treatment strategies for these patients.

DECLARATIONS
Authors’ contributions
Literature research, writing and editing: Pecoraro A
Literature research writing: Diana P

Availability of data and materials
Not applicable.