RFA versus robotic partial nephrectomy for T1a renal cell carcinoma:
a propensity score-matched comparison of mid-term outcome
Byung Kwan Park
In Hyuck Gong
Min Yong Kang
Hyun Hwan Sung
Hwang Gyun Jeon
Byong Chang Jeong
Seong Soo Jeon
Hyun Moo Lee
Seong Il Seo
Received: 23 September 2017 /Revised: 26 December 2017 /Accepted: 2 January 2018 /Published online: 9 February 2018
European Society of Radiology 2018
Objective To compare oncological and functional mid-term outcomes following robotic partial nephrectomy (RPN) and radio-
frequency ablation (RFA) for treating T1a renal cell carcinoma (RCC) using propensity score-matching.
Methods Between December 2008–April 2016, 63 patients from each treatment group were propensity score-matched for age,
sex, American Society of Anesthesiologists score, tumour size, tumour laterality, tumour histology, R.E.N.A.L. nephrometry
score and preoperative estimated glomerular filtration rate (eGFR). Post-treatment follow-up periods for RPN and RFA ranged
from 1–90 months (median, 24.6) and 1–65 months (21), respectively. Tumour location, percentage of eGFR preservation and 2-
year recurrence-free survival rate were compared between groups.
Results Exophytic and endophytic RCC occurred in 73.0 % (46/63) and 27.0 % (17/63) of the RPN group, and 52.4 % (33/63)
and 47.6 % (30/63) of the RFA group, respectively (p=0.017). There was 91.7 % preservation of eGFR in the RPN group and
86.8 % in the RFA group (p=0.088). Two-year recurrence-free survival rate was 100 % in the RPN and 95.2 % in the RFA group
Conclusions RPN provides a higher recurrence-free survival rate than RFA. However, RFA is a better treatment option for an
endophytic or recurrent RCC that is difficult to treat with RPN.
• RPN provides a higher recurrence-free survival rate than RFA.
• Unlike RPN, repeat RFA is easy to perform for recurrent RCC.
• Endophytic RCC could be better treated with RFA.
Keywords Radiofrequency catheter ablation
Carcinoma, Renal cell
ASA American Society of Anesthesiology
eGFR Estimated glomerular filtration rate
R.E.N.A.L. Radius, Exophytic/Endophytic, Nearness to
collecting system, Anterior/Posterior, Location
relative to polar lines
RCC Renal cell carcinoma
RFA Radiofrequency ablation
RPN Robotic partial nephrectomy
Incidental renal cell carcinoma (RCC) is increasingly detected
on cross-sectional imaging that is performed for unrelated
reasons. Frequently, the RCC-associated tumours measure
less than 4 cm (stage T1a) [1, 2]. Nephron-sparing surgery is
the treatment of choice for RCC, but radiofrequency ablation
(RFA) is accepted as a treatment option in patients with poor
general condition [3–6].
Recently, the mid-term or long-term outcomes of robotic
partial nephrectomy (RPN) and RFA have been reported.
These treatment modalities are considered minimally
* Seong Il Seo
Department of Radiology, Samsung Medical Center, Sungkyunkwan
University School of Medicine, Seoul, Republic of Korea
Department of Urology, Samsung Medical Center, Sungkyunkwan
University School of Medicine, Seoul 135-710, Republic of Korea
European Radiology (2018) 28:2979–2985