Robot-assisted partial nephrectomy vs. percutaneous cryoablation for T1a renal tumors: a single-center retrospective analysis of outcomes and costs

• Published in: International urology and nephrology 2024-11
• Main Authors: Iossa, Vincenzo, Pandolfo, Savio Domenico, Buonopane, Roberto, Di Girolamo, Antonio, Fiore, Felice, Sessa, Gaetano, Vitale, Raffaele, Ferraro, Angelo, Amodeo, Enrico Maria, Porcaro, Piercarmine, Punzi, Ernesto, Lombardi, Giulio, Imperatore, Vittorio
• Format: Article
• Language: English
• ISSN: 1573-2584; 1573-2584
• DOI: 10.1007/s11255-024-04238-8

The aim of this study is to compare perioperative, functional, and oncological outcomes between robot-assisted partial nephrectomy (RAPN) and cryoablation (CRYO), based on a 3-year experience at our Institution. Additionally, a secondary aim is to conduct a comparative cost analysis between the two procedures. A retrospective analysis was conducted, including patients who underwent RAPN or CRYO between January 2020 and December 2023. Group 1 consisted of 59 patients who underwent RAPN, while Group 2 included 38 patients who had CRYO. The evaluation parameters included baseline characteristics, perioperative, functional, and oncological outcomes, as well as total hospitalization costs. Operative time (OT), average length of hospital stay (LOS), and emetic blood loss (EBL) were significantly lower in the CRYO group. Furthermore, CRYO showed a significantly lower rate of postoperative complications of any grade (7.8% vs 16.9%); however, this was associated with a considerably higher recurrence rate (5.7% vs 1.7%). No substantial differences were found in long-term functional outcomes (ΔeGFR). In terms of costs, CRYO was more cost-effective than RAPN (€5473 vs €10,672), although the gap was partially offset by a higher reimbursement "DRG" rate for robotic partial nephrectomy (€7386 vs €4384). Robot-assisted partial nephrectomy (RAPN) remains the preferred option for treating small renal masses (sRM), providing excellent oncological results and acceptable morbidity. However, percutaneous cryoablation is a valid alternative, particularly for patients unfit for surgery, as long as meticulous postoperative follow-up is carried out.