Comparison of operative and oncologic results between partial nephrectomy and radiofrequency ablation for treatment of renal tumors in patients older than 75]

Introduction. - Elderly patients represent a growing part of our society for who treatment strategy for localized renal tumors has to be chosen knowing iatrogen effects and renal function morbidity. The aim was to analyze oncological and functional results of nephron sparing surgery (PN) versus radiofrequency ablation (RFA). Materials and methods. - All patients aged more than 75 treated by partial nephrectomy or radiofrequency ablation between 2007 and 2014 in our centre were included. Patient and tumors data were compared and these criteria were analyzed: survival (overall and without recurrence) and loss of renal function (pre- and postoperative MDRD). Results. - In total, 100 patients were included (26 partial nephrectomies, group 1 and 74 radio frequency ablation, group 2) with a 32-months medium follow-up. Medium age and tumor size were significantly different (respectively, 78 versus 81 years old, P = 0.001, 38 mm versus 29 mm, P = 0.003). Perioperative results showed no differences in complications. Transfusion rate and duration of hospital stay were significantly higher in the PN group. Median overall survival were 45 vs. 27 months (P = 0.23) for PN and RFA and median recurrence-free survival were 28 vs. 10 months (P = 0.34). On a multivariate analysis, operative technique (PN or RFA) were not significantly linked to survival (HR 2.37 [95% CI: 0.66-8.5]), P = 0.19. Loss of renal function were 1.5 +/- 14 mL/min/1.73 m(2) for PN and 3 +/- 14 mL/min/1.73 m(2) for RFA (P = 0.69). Conclusion. - Our study showed better perioperative results for RFA than for PN, without significant different survival. Loss of renal function were little and similar. (C) 2017 Elsevier Masson SAS. All rights reserved.