Achieving no evidence of disease in metastatic renal cell carcinoma: Consolidative nephrectomy vs ablative therapy.

INTRODUCTION Systemic therapies (ST1) have improved outcomes in metastatic renal cell carcinoma (mRCC2) but have a limited effect on the primary renal tumor. As deeper responses improve survival, consolidative treatment (CT3) to achieve "No Evidence of Disease" is increasingly considered. While surgery remains the standard, renal cryoablation (CA4), a less invasive option, is gaining interest.

MATERIAL AND METHODS We conducted a retrospective single-center study (2010-2025) of synchronous mRCC patients undergoing CT after achieving a complete metastatic response with ICI±TKI. Evaluated modalities included partial nephrectomy (PN5), radical nephrectomy (RN6), and CA. The primary objective was the oncological efficacy of each modality, measured by the 1-year recurrence rate. Secondary objectives included overall recurrence-free survival (RFS7) and morbidity.

RESULTS Twenty-one patients underwent CT: 10 PN, 7 RN, and 4 CA. Median age was 65 years. Seventeen patients (81%) received ICI±TKI, and four (19%) received TKI alone. Median preoperative tumor sizes were 43.5, 68, and 25mm in the PN, RN, and CA groups, respectively (P=0.01). Median follow-up was 31 (23.5-73.5) months. The 1-year recurrence rates were comparable: 22.2% (PN), 16.7% (RN), and 25% (CA) (P=0.61). ST was discontinued postoperatively in 84% (16/19) of patients. Although not statistically significant, CA showed a trend toward lower morbidity than consolidative nephrectomy (CN8), with better preservation of renal function, less blood loss, and shorter hospital stays.

CONCLUSION Consolidative renal CA, with its reduced morbidity, could be a viable alternative for frail patients unfit for CN, warranting validation in larger prospective studies. LEVEL OF EVIDENCE (HAS): 4 (descriptive studies).