Real-Time Contrast-Enhanced Ultrasound Combined with Ultrasound Monitoring Radiofrequency Ablation Versus Laparoscopic Partial Nephrectomy for cT1a Renal Cell Carcinoma: A Comparative Study with Mid-Term Follow-Up

Abstract

Objective The study aims to compare oncological and functional mid-term outcomes following real-time contrast-enhanced ultrasound combined with ultrasound monitoring radiofrequency ablation (CEUS/USM-RFA) versus laparoscopic partial nephrectomy (LPN) for treating cT1a renal cell carcinoma (RCC). Methods This is a retrospective data analysis of a high-volume single tertiary center. Patients with cT1a RCC were treated with CEUS/USM-RFA or LPN following multidisciplinary decision-making. According to different surgical methods, patients were divided into the RFA and LPN groups. Demographic information, tumor characteristics, surgical data, complications, and functional and oncological outcomes were reviewed. Differences between categorical and continuous parameters were evaluated using Pearson's chi-square and Student's t-tests, respectively. Results According to different surgical methods, 164 patients were divided into the RFA (41 cases) and LPN (123 cases) groups. The results revealed a nonsignificant difference in gender, tumor side, tumor size, RCC type, R.E.N.A.L. score, major complications, technical success, technique efficacy, or local tumor progression (LTP) between the two groups (p > 0.05). However, significant differences were observed in age, Eastern Cooperative Oncology Group (ECOG) score, Charlson Comorbidity Index (CCI) score, American Society of Anesthesiologist (ASA) score, tumor location, and minor complications (p < 0.05). The operative time, estimated blood loss, hospitalization time, and estimated glomerular filtration rate (eGFR) loss of the affected kidney in the RFA group were less than in the LPN group (p < 0.05). The decline of post-procedure eGFR of the affected kidney at six months was significantly less in RFA than in the LPN group (1.39 ± 4.67 vs. 4.32 ± 4.00 mL/min/1.73 m², p < 0.001). Nevertheless, both groups had a similar 2-year recurrence-free survival (RFS) rate (97.65% vs. 100%, p = 0.083). Conclusion The CEUS/USM-RFA and LPN for cT1a RCC were all safe and effective. In rigorously screened patients with cT1a RCC, CEUS/USM-RFA had comparable oncological outcomes with LPN. The CEUS/USM-RFA had superiority in perioperative outcomes and preserving renal function.