| Background:Renal cell carcinoma(RCC)mainly refers to heterogeneous renal cancers originating from the proximal tubule,accounting for more than 90% of all renal cancers,and is the third most commonly diagnosed malignancy of the genitourinary system.For patients with good clinical indications for surgery for stage T1 a renal cell carcinoma(i.e.,c T1a),current guidelines recommend Laparoscopic Partial Nephrectomy(LPN)as the treatment of choice.Compared to Laparoscopic Radical Nephrectomy(LRN),LPN has similar treatment outcomes and a good prognosis for renal function.In contrast,for patients who refuse surgery or are not suitable for surgical treatment,have a potential risk of complications,and have preexisting renal impairment,thermal ablation techniques facilitate the preservation of renal parenchyma and a smaller surgical incision,and are now one of the radical approaches for the treatment of stage T1 a renal cell carcinoma in many guidelines [14,52].Microwave ablation(MWA)is one of the most recent and satisfying research advances in thermal ablation techniques.Thus,percutaneous microwave ablation and laparoscopic partial nephrectomy are two approaches to treat early-stage renal cell carcinoma,and robotic-assisted laparoscopic partial nephrectomy(RAPN)is a further development following laparoscopic partial nephrectomy in recent years,and several studies have shown that for challenging cases,robotic Some studies have shown that robotic-assisted laparoscopic partial nephrectomy is more beneficial than laparoscopic partial nephrectomy for challenging cases.There are few comparative analyses of the efficacy of percutaneous microwave ablation and laparoscopic partial nephrectomy for stage cT1a renal cancer in China and abroad,and there is a lack of evidence of differences in survival outcomes,and there are no reports on the comparative efficacy of percutaneous microwave ablation and robotic-assisted laparoscopic partial nephrectomy for stage cT1a renal cancer.laparoscopic partial nephrectomy for the treatment of stage cT1a renal cancer.This is a clinical retrospective study,in which consecutive included patients were retrieved through the electronic clinical record system of the PLA General Hospital,and each patient was followed up for at least 20 months after surgery,divided into two parts for the study,and the advantages and disadvantages of percutaneous microwave ablation are discussed.Part Ⅰ Percutaneous microwave ablation versus laparoscopic partial nephrectomy comparison of treatment of cT1a renal cell carcinomaObjective To compare the clinical efficacy of ultrasound-guided percutaneous microwave ablation(MWA)with laparoscopic partial nephrectomy(LPN)for cT1a stage renal cell carcinoma,to clarify the status of percutaneous MWA in renal preservation surgery,and to provide a basis for evidence-based medicine in a sample.Methods This is a clinical retrospective study that retrospectively analysed 1749 patients treated with laparoscopic partial nephrectomy(LPN)and 249 patients treated with percutaneous microwave ablation(MWA)and diagnosed with stage cT1a renal cell carcinoma between April 2006 and December 2019,retrieved through the electronic clinical record system of the PLA General Hospital.Factors included in the analysis were baseline patient characteristics(age,sex ratio and Charlson comorbidity index,maximum tumour diameter,number of tumours,tumour pathology type,tumour location,adjacent organs,blood supply to the lesion),treatment parameters(operative time,estimated intraoperative blood loss,postoperative hospital days,hospital costs),postoperative follow-up indicators(serious complications,mean number of febrile days),prognostic evaluation The patients in the two groups were evaluated using the propensity test(local tumor progression(LTP),cancer specific survival(CSS),overall survival(OS)and disease-free survival(DFS)).The two groups of patients were matched using propensity score matching in a 1:1 caliper matching method.Prognostic risk factors were analysed for LTP,CSS,OS and DFS using univariate correlation analysis and multivariate linear regression analysis.Results 1.After matching,MWA was associated with less intraoperative estimated blood loss(4.5 ± 1.3 vs 54.2 ± 69.2 m L,P < 0.001),lower hospitalization costs(3.1 ± 1.4 vs 4.3 ±19,000 yuan,P < 0.001),and shorter operation time(26.2 ± 3.5 vs 108.3 ± 27.5 minutes,P <0.001)and postoperative hospital stay(5.2 ± 2.6 vs 6.7 ± 2.4 days,P < 0.001)compared with laparoscopic partial nephrectomy(LPN).2.Compared with LPN group,MWA group had fewer mean fever days after matching(1.2 vs1.6 days,P = 0.042),and the difference was statistically significant,while there was no significant difference in serious complications between the two groups([2.3%] vs [4.7%],P =0.11).3,during the follow-up period(median 55.3 months in the MWA group and 64.2 months in the LPN group),there were significant differences in LTP,DFS,CSS and OS between the two groups before matching(P < 0.05).There was no significant difference in CSS,LTP and OS after matching(P = 0.238;P = 0.736;P = 0.056),and DFS was lower in the MWA group,with statistical significance(P < 0.05).Conclusion 1.MWA and LPN,as the preferred treatment for cT1a stage renal cancer,have relatively good therapeutic effects,and the 1-year and 5-year survival rates of patients are about 95%.2.After 1:1 propensity score matching,consistent baseline levels were achieved,with lower disease-free survival(DFS),but local tumor progression(LTP),cancer-specific survival(CSS),and overall survival(OS)in the MWA group compared with the LPN group no significant difference was found.3.Age and comorbidity index are the main factors affecting various indicators of prognosis,and cT1a renal cancer patients with advanced age and many comorbidities have a poor prognosis.4.Compared with laparoscopic partial nephrectomy,MWA group had shorter operation time,shorter postoperative hospital stay,lower cost,lower probability of fever and less intraoperative blood loss.Part Ⅱ Percutaneous microwave ablation and robot-assisted partial renal resection for cT1a renal cell carcinomaObjective To compare the clinical efficacy of microwave ablation and robot-assisted partial nephrectomy in the treatment of cT1a stage renal cell carcinoma,and to provide more treatment options according to the specific circumstances of patients with early renal cell carcinoma.Methods This was a clinical retrospective study in which 704 patients who underwent robotassisted laparoscopic partial nephrectomy(RAPN)and 283 patients who underwent microwave ablation(MWA)and were diagnosed with cT1a stage renal cell carcinoma from April 2006 to December 2020 were retrospectively analyzed by searching and consecutively enrolling patients through the electronic clinical record system of the Chinese PLA General Hospital.The included analysis factors included baseline characteristics of patients(age,gender,preoperative creatinine level,preoperative e GFR and Charlson comorbidity index,maximum tumor diameter,tumor number,tumor pathological type,tumor location),treatment parameters(operation time,hospital stay,hospitalization costs),postoperative follow-up indicators(serious complications,fever,postoperative e GFR),prognostic evaluation indicators(postoperative metastasis,LTP,CSS,OS and DFS).The above contents were compared and analyzed.Cox proportional hazards regression model was established to adjust the baseline imbalance factors to compare the occurrence of adverse events between the two groups.The two groups of patients were matched 1:1 with calipers using the propensity score matching method.The confounding factors were adjusted and compared.Results 1.Compared with robot-assisted laparoscopic partial nephrectomy(RAPN),percutaneous MWA showed shorter operation time before and after matching(before matching: 7.21 ± 2.97 vs 120.91 ± 39.93 minutes,P < 0.001;after matching: 6.46 ± 2.44 vs121.95 ± 41.08 minutes,P < 0.001)and hospital stay(before matching: 5.25 ± 2.86 vs 11.07± 3.69 days,P < 0.001;after matching: 5.21 ± 3.28 vs 11.15 ± 3.23 days,P < 0.001).The inpatient medical costs of MWA were also lower than those of RAPN group(before matching:3.2 ± 1.5 vs 7.3 ± 0.9 million yuan,P < 0.001;after matching: 3.2 ± 1.5 vs 7.3 ± 0.5 million yuan,P < 0.001).2.The change of e GFR before and after treatment in MWA group was lower than that in RAPN group(before matching: 12.0% vs 17.0%,P < 0.001;after matching: 11.6% vs 23.3%,P < 0.001),and the number of fever cases in MWA group was lower than that in RAPN group(before matching: 19.79% vs 57.39%,P < 0.001;after matching: 23.23% vs 46.46%,P <0.001).There was no difference in the probability of major complications between the two groups(P = 0.293).3.There was a certain difference in the incidence of adverse events between the percutaneous MWA group and the RAPN group during follow-up(median 46 months in the MWA group and 59.5 months in the RAPN group).Cox proportional hazards regression model analysis showed that before matching,MWA group had higher incidence of distant metastasis and LTP,and lower DFS,OS and CSS(P < 0.001);after matching,MWA group had no significant difference in LTP,OS and CSS compared with RAPN group(P = 0.53;P = 0.70;P = 0.32),only higher incidence of distant metastasis and lower DFS(P < 0.05).Conclusion 1.Compared with robot-assisted laparoscopic partial nephrectomy,MWA group had shorter operation time,shorter postoperative hospital stay,lower cost,lower probability of fever and less damage to renal function.2.After matching,the baseline level of Lazi was further adjusted for confounding factors.Compared with the RAPN group,the MWA group had a higher incidence of distant metastasis and lower disease-free survival(DFS),which were significantly different;while local tumor progression(LTP),cancer There were no significant differences in specific survival(CSS)and overall survival(OS).3.Microwave ablation(MWA)can be a safe and effective treatment for patients with cT1a stage renal cell carcinoma who have poor physical condition,cannot tolerate surgery or refuse surgery. |
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