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

• Published in: Cardiovascular and interventional radiology Vol. 44; no. 6; pp. 892 - 900
• Main Authors: Garcia, Rodrigo Gobbo, Katz, Marcelo, Falsarella, Priscila Mina, Malheiros, Daniel Tavares, Fukumoto, Helena, Lemos, Gustavo Caserta, Teich, Vanessa, Salvalaggio, Paolo Rogério
• Format: Journal Article
• Language: English
• Published: New York Springer US 01.06.2021; Springer Nature B.V
• Subjects: Cardiology; Clinical Investigation; Complications; Cost analysis; Decision trees; Heart diseases; Hospital costs; Imaging; Interventional Oncology; Kidney cancer; Medicine; Medicine & Public Health; Nephrectomy; Nuclear Medicine; Patients; Radiology; Robots; Tumors; Ultrasound; United States > US; Cryoablation; Intraoperative complications; Renal cancer; Cost-effectiveness; Robotic surgical procedure
• ISSN: 0174-1551; 1432-086X
• DOI: 10.1007/s00270-020-02732-x

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.