Comparison of Postoperative Complications and Mortality Between Laparoscopic and Percutaneous Local Tumor Ablation for T1a Renal Cell Carcinoma: a Population-Based Study

OBJECTIVE: To evaluate potential differences in local tumor ablation (LTA) perioperative outcomes between the percutaneous (pLTA) and the laparoscopic (lapLTA) approach.

METHODS: Using the Surveillance, Epidemiology, and End Results (SEER)-Medicare, we identified all patients diagnosed with T1a RCC who underwent either pLTA or lapLTA between 2000 and 2009. Overall complications at 30-day and mortality at 90-day were examined for both groups. A multivariable logistic regression model was fitted to evaluate the effect of the approach on perioperative complications. A second model was fitted to test for associations between patient or tumor characteristics and type of LTA approach.

RESULTS: Overall, 516 patients diagnosed with T1a RCC were identified. Of those, 289 (56%) were treated with pLTA and 227 (44%) with lapLTA. LapLTA treated patients were younger (median 76 vs. 78, p<0.001) and healthier (median CCI 2.1 vs. 2.7, p=0.03) than their counterpart. Following pLTA and lapLTA, overall complications rates were 21 and 25%, respectively (p=0.3). Similarly, 90-day mortality rates did not differ between the two groups (p=1). After adjusting for patient and tumor characteristics, LTA approach was not associated with perioperative complications (Odds Ratio (OR): 1.38, p=0.1). However, older and sicker patients were less likely to be treated with lapLTA (both ≤0.04).

CONCLUSIONS: No differences in 30-day overall complications or 90-day mortality rates were detected between lapLTA and pLTA for T1a RCC. pLTA was more frequently used in older and sicker individuals. Further prospective studies comparing both procedures should be undertaken.