Open and minimally-invasive partial nephrectomy or thermal ablation for localized renal tumors in the United States: insurance claims data on perioperative outcomes and healthcare costs

BACKGROUND: Partial nephrectomy (PN) is the gold-standard treatment for T1 renal-cell carcinoma, which is associated with a significant risk of complications. Tumor ablation (TA) can be implemented in chosen patients with small renal masses. The aim was to evaluate perioperative outcomes and health-care costs of PN and TA. METHODS: Patients aged ≥18 with renal mass diagnosis, who underwent PN/TA in 2007-2021, were identified in the Merative™ Marketscan® Research Commercial and Medicare databases. Complication rates, probability and time to second surgery, as well as hospital costs (2021 US dollars) of PN and TA were evaluated. The rate of preoperative renal mass biopsies over the years was assessed. Finally, subgroup analyses for types of second surgeries (TA, PN, radical nephrectomy) were performed. RESULTS: Twenty-four thousand forty-five patients with kidney tumors were included. The majority (85.7%) underwent PN. Over the years, preoperative renal biopsies have become more common. TA was associated with a significantly lower risk of complications (adjusted odds ratio [aOR]: 0.56, 95% confidence interval [CI]: 0.50-0.63) and lower costs (aOR: 0.23, 95% CI: 0.20-0.26) than PN. The analysis of specific complications found that only wound-related complications had no significant difference in risk between the procedures (aOR: 0.65, 95%CI: 0.41-1.02). However, TA patients were at higher risk of a second procedure (adjusted hazard ratio: 1.25, 95%CI: 1.05-1.49). CONCLUSIONS: TA is associated with significantly fewer complications and lower costs than PN. However, patients undergoing TA require re-operation more frequently, possibly due to higher recurrence rates. These factors need to be considered when selecting the most appropriate treatment for patients with renal tumors.