sPaRT2 - Minimally Invasive Partial versus Radical Nephrectomy for cT2 Renal Cell Carcinoma: A National Matched-Pair Analysis (UroCCR 235).

Abstract

Radical nephrectomy (RN) remains the standard treatment for cT2 renal cell carcinoma (RCC), but partial nephrectomy has emerged as a viable alternative with the development of robot-assisted approaches. However, robust comparative data between robot-assisted partial nephrectomy (RAPN) and RN for large renal tumors remain limited. We conducted a multicenter retrospective study using prospectively collected data from the UroCCR network (NCT03293563). Patients undergoing RAPN or minimally invasive RN for cT2M0 RCC were matched 1:1 using propensity scores based on clinical and tumor characteristics. Primary outcome was 5-year disease-free survival (DFS). Secondary endpoints included overall survival (OS), renal function, perioperative outcomes, complications, and Trifecta achievement. Out of 847 patients included, 250 RAPN and 250 RN were matched. Median tumor size was 8.2 cm in RN group and 8 cm in RAPN group. Oncologic outcomes were comparable: five-year DFS was 61% and 49% (p=0.2), CSS was 87% and 94% (p=0.8), MFS was 71% and 66% (p=0.4), and OS was 80% and 80% (p=0.5), for RAPN and RN, respectively. RAPN was associated with improved renal function preservation (median ΔeGFR at 5 years: -15 vs. -23 mL/min/1.73 m²), fewer CKD stage migrations, and reduced acute kidney injury. Major complications were more frequent after RAPN (6% vs. 2%, p = 0.04). The Trifecta outcome was achieved in 46% of RAPN cases. RAPN is a safe and functionally superior alternative to RN for selected patients with cT2 RCC. While associated with higher perioperative morbidity, these risks are acceptable in expert centers and offset by long-term nephron-sparing benefits.