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Percutaneous Cryoablation versus Robot-Assisted Partial Nephrectomy of Renal T1A Tumors: a Single-Center Retrospective Cost-Effectiveness Analysis

  • Clinical Investigation
  • Interventional Oncology
  • Published:
CardioVascular and Interventional Radiology Aims and scope Submit manuscript

Abstract

Purpose

To evaluate the cost-effectiveness of percutaneous cryoablation (PCA) versus robot-assisted partial nephrectomy (RPN) in patients with small renal tumors (T1a stage), considering perioperative complications.

Materials and Methods

Retrospective study from November 2008 to April 2017 of 122 patients with a T1a renal mass who after being analyzed by a multidisciplinary board underwent to PCA (59 patients) or RPN (63 patients). Hospital costs in US dollars, and clinical and tumor data were compared. Non-complicated intervention was considered as an effective outcome. A hypothetical model of possible complications based on Clavien–Dindo classification (CDC) was built, grouping them into mild (CDC I and II) and severe (CDC III and IV). A decision tree model was structured from complications of published data.

Results

Patients who underwent PCA were older (62.5 vs. 52.8 years old, p < 0.001), presented with more coronary disease and previous renal cancer (25.4% vs. 10.1%, p = 0.023 and 38% vs. 7.2%,  p < 0.001, respectively). Patients treated with PCA had a higher preoperative risk (American Society of Anesthesiologists—ASA ≥ 3) than those in the RPN group (25.4% vs. 0%, p < 0.001). Average operative time was significantly lower with PCA than RPN (99.92 ± 29.05 min vs. 129.28 ± 54.85 min, p < 0.001). Average hospitalization time for PCA was 2.2 ± 2.95 days, significantly lower than RPN (mean 3.03 ± 1.49 days, p = 0.04). The average total cost of PCA was significantly lower than RPN (US$12,435 ± 6,176 vs. US$19,399 ± 6,047, p < 0.001). The incremental effectiveness was 5% higher comparing PCA with RPN, resulting a cost-saving result in favor of PCA.

Conclusion

PCA was the dominant strategy (less costly and more effective) compared to RPN, considering occurrence of perioperative complications.

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References

  1. Campbell SC, Faraday M, Uzzo RG. Small renal mass. N Engl J Med. 2010;362(24):2334.

    Article  CAS  Google Scholar 

  2. Turner RM 2nd, Morgan TM, Jacobs BL. Epidemiology of the small renal mass and the treatment disconnect phenomenon. Urol Clin North Am. 2017;44(2):147–54.

    Article  Google Scholar 

  3. Hollingsworth JM, Miller DC, Daignault S, Hollenbeck BK. Rising incidence of small renal masses: a need to reassess treatment effect. J Natl Cancer Inst. 2006;98(18):1331–4.

    Article  Google Scholar 

  4. Pierorazio PM, Johnson MH, Patel HD, Sozio SM, Sharma R, Iyoha E, et al. Management of renal masses and localized renal cancer: systematic review and meta-analysis. J Urol. 2016;196(4):989–99.

    Article  Google Scholar 

  5. Katsanos K, Mailli L, Krokidis M, McGrath A, Sabharwal T, Adam A. Systematic review and meta-analysis of thermal ablation versus surgical nephrectomy for small renal tumours. Cardiovasc Intervent Radiol. 2014;37(2):427–37.

    Article  CAS  Google Scholar 

  6. Leow JJ, Heah NH, Chang SL, Chong YL, Png KS. Outcomes of robotic versus laparoscopic partial nephrectomy: an updated meta-analysis of 4,919 patients. J Urol. 2016;196(5):1371–7.

    Article  Google Scholar 

  7. Thompson RH, Atwell T, Schmit G, Lohse CM, Kurup AN, Weisbrod A, et al. Comparison of partial nephrectomy and percutaneous ablation for cT1 renal masses. Eur Urol. 2015;67(2):252–9.

    Article  Google Scholar 

  8. Agrawal S, Sedlacek H, Kim SP. Comparative effectiveness of surgical treatments for small renal masses. Urol Clin North Am. 2017;44(2):257–67.

    Article  Google Scholar 

  9. Shakeri S, Raman SS. Percutaneous thermal ablation for treatment of T1a renal cell carcinomas. Radiol Clin North Am. 2020;58(5):981–93.

    Article  Google Scholar 

  10. Lim E, Kumar S, Seager M, et al. Outcomes of renal tumors treated by image-guided percutaneouscryoablation:immediate and 3-and 5-year outcomes at a regional center. AJR Am J Roentgenol. 2020;215(1):242–7.

    Article  Google Scholar 

  11. Hanzly M, Frederick A, Creighton T, et al. Learning curves for robot-assisted and laparoscopic partial nephrectomy. J Endourol. 2015;29(3):297–303.

    Article  Google Scholar 

  12. Kunkle DA, Uzzo RG. Cryoablation or radiofrequency ablation of the small renal mass: a meta-analysis. Cancer. 2008;113(10):2671–80.

    Article  Google Scholar 

  13. Gervais DA. Cryoablation versus radiofrequency ablation for renal tumor ablation: time to reassess? J Vasc Interv Radiol. 2013;24(8):1135–8.

    Article  Google Scholar 

  14. Bhan SN, Pautler SE, Shayegan B, Voss MD, Goeree RA, You JJ. Active surveillance, radiofrequency ablation, or cryoablation for the nonsurgical management of a small renal mass: a cost-utility analysis. Ann Surg Oncol. 2013;20(11):3675–84.

    Article  Google Scholar 

  15. Katz M, Franken M, Makdisse M. Value-based health care in Latin America: an urgent discussion. J Am Coll Cardiol. 2017;70(7):904–6.

    Article  Google Scholar 

  16. Chehab M, Friedlander JA, Handel J, et al. Percutaneous cryoablation vs partial nephrectomy: cost comparison of T1a tumors. J Endourol. 2016;30(2):170–6.

    Article  Google Scholar 

  17. Sidi A, Lobato EB, Cohen JA. The american society of anesthesiologists’ physical status: category V revisited. J Clin Anesth. 2000;12(4):328–34.

    Article  CAS  Google Scholar 

  18. Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg. 2004;240(2):205–13.

    Article  Google Scholar 

  19. Rothen HU, Stricker K, Einfalt J, et al. Variability in outcome and resource use in intensive care units. Intensive Care Med. 2007;33(8):1329–36.

    Article  Google Scholar 

  20. Sogayar AM, Machado FR, Rea-Neto A, et al. Costs study group - latin american sepsis institute a multicentre, prospective study to evaluate costs of septic patients in brazilian intensive care units. Pharmacoeconomics. 2008;26(5):425–34.

    Article  Google Scholar 

  21. Kapoor A, Wang Y, Dishan B, Pautler SE. Update on cryoablation for treatment of small renal mass: oncologic control, renal function preservation, and rate of complications. Curr Urol Rep. 2014;15(4):396.

    Article  Google Scholar 

  22. Lotan Y, Cadeddu JA. A cost comparison of nephron-sparing surgical techniques for renal tumour. BJU Int. 2005;95(7):1039–42.

    Article  Google Scholar 

  23. Pandharipande PV, Gervais DA, Mueller PR, Hur C, Gazelle GS. Radiofrequency ablation versus nephron-sparing surgery for small unilateral renal cell carcinoma: cost-effectiveness analysis. Radiology. 2008;248(1):169–78.

    Article  Google Scholar 

  24. Laydner H, Isac W, Autorino R, et al. Single institutional cost analysis of 325 robotic, laparoscopic, and open partial nephrectomies. Urology. 2013;81(3):533–8.

    Article  Google Scholar 

  25. Buse S, Hach CE, Klumpen P, et al. Cost-effectiveness of robot-assisted partial nephrectomy for the prevention of perioperative complications. World J Urol. 2016;34(8):1131–7.

    Article  Google Scholar 

  26. Dobbs RW, Magnan BP, Abhyankar N, et al. Cost effectiveness and robot-assisted urologic surgery: does it make dollars and sense? Minerva Urol Nefrol. 2017;69(4):313–23.

    PubMed  Google Scholar 

  27. Jeong IG, Khandwala YS, Kim JH, et al. Association of robotic-assisted vs laparoscopic radical nephrectomy with perioperative outcomes and health care costs, 2003–2015. JAMA. 2017;318(16):1561–8.

    Article  Google Scholar 

  28. Azevedo AA, Rahal Junior A, Falsarella PM, et al. Image-guided percutaneous renal cryoablation: five years experience, results and follow-up. Eur J Radiol. 2018;100:14–22.

    Article  Google Scholar 

Download references

Acknowledgements

We thank Dr. Eliezer Silva for his useful insights to the economic model, Mr. Rogério Ruscitto do Prado for assistance with statistical analysis and Ms. Fernanda Marques Abatepaulo for help with data collection and imaging analysis.

Funding

This study was not supported by any funding.

Author information

Authors and Affiliations

  1. Center of Interventional Medicine, Hospital Israelita Albert Einstein, Av. Albert Einstein, 627- 4º andar – Bloco B, São Paulo, SP, 05652-900, Brazil

    Rodrigo Gobbo Garcia & Priscila Mina Falsarella

  2. Department of Cardiology, Hospital Israelita Albert Einstein, Av. Albert Einstein, 627- 4o andar – Bloco A1, São Paulo, SP, 05652-900, Brazil

    Marcelo Katz

  3. Value Management Office, Hospital Israelita Albert Einstein, Av. Albert Einstein, 627- 8º andar- bloco D, São Paulo, SP, 05652-900, Brazil

    Daniel Tavares Malheiros

  4. Financial Division, Hospital Israelita Albert Einstein, Av. Albert Einstein, 627- 3º andar – Bloco E, São Paulo, SP, 05652-900, Brazil

    Helena Fukumoto

  5. Urology Department, Hospital Israelita Albert Einstein, Av. Albert Einstein, 627- 4 andar – Bloco E, São Paulo, SP, 05652-900, Brazil

    Gustavo Caserta Lemos

  6. Healthy Economics Division, Hospital Israelita Albert Einstein, Av. Albert Einstein, 627- 8 andar – Bloco D, São Paulo, SP, 05652-900, Brazil

    Vanessa Teich

  7. Abdominal Surgery Division & Albert, Einstein Medical School, Hospital Israelita Albert Einstein, Av. Albert Einstein, 627- 1oSS – Bloco A, São Paulo, SP, 05652-900, Brazil

    Paolo Rogério Salvalaggio

Authors
  1. Rodrigo Gobbo Garcia
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  2. Marcelo Katz
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  3. Priscila Mina Falsarella
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Correspondence to Priscila Mina Falsarella.

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This study has obtained IRB approval from Hospital Israelita Albert Einstein Ethical Committee, and the need for informed consent was waived.

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Garcia, R.G., Katz, M., Falsarella, P.M. et al. Percutaneous Cryoablation versus Robot-Assisted Partial Nephrectomy of Renal T1A Tumors: a Single-Center Retrospective Cost-Effectiveness Analysis. Cardiovasc Intervent Radiol 44, 892–900 (2021). https://doi.org/10.1007/s00270-020-02732-x

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  • DOI: https://doi.org/10.1007/s00270-020-02732-x

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