部分肾切除术（PN）是治疗cT1b肾肿瘤的金标准治疗方案。经皮引导热消融术（TA）已被证明在治疗小肾肿瘤（<3 cm）方面具有良好的肿瘤学疗效和低发病率。最近，研究了3D图像引导下机器人辅助部分肾切除术（3D-IGRAPN），并报道了较标准机器人辅助部分肾切除术（RAPN）有较低的围手术期发病率。我们的目标是比较两种微创的图像引导下保留肾单位的治疗方案（TA和3D-IGRAPN）在治疗cT1b肾细胞癌（4.1-7 cm）方面的效果。将在UroCCR数据库（NCT03293563）中前瞻性收集TA和3D-IGRAPN治疗的cT1b肾细胞癌病人按肿瘤大小、病理和RENAL评分进行配对。主要终点是两组之间的局部复发率。次要终点包括转移进展、围手术期并发症、肾功能下降和住院时间。总共包括198例病人，分为两组，每组72例病人。TA组的局部复发率明显高于3D-IGRAPN组（4.2% vs. 15.2%，P=0.04）。转移进展和围手术期结局（如重大并发症、eGFR下降和住院时间）在两组之间没有明显差异。与热消融相比，3D-IGRAPN具有明显较低的局部复发率和相当的并发症和转移进展率。

Partial nephrectomy (PN) is the gold standard treatment for cT1b renal tumors. Percutaneous guided thermal ablation (TA) has proven oncologic efficacy with low morbidity for the treatment of small renal masses (<3 cm). Recently, 3D image-guided robot-assisted PN (3D-IGRAPN) has been described, and decreased perioperative morbidity compared to standard RAPN has been reported. Our objective was to compare two minimally invasive image-guided nephron-sparing procedures (TA vs. 3D-IGRAPN) for the treatment of cT1b renal cell carcinomas (4.1-7 cm).Patients treated with TA and 3D-IGRAPN for cT1b renal cell carcinoma, prospectively included in the UroCCR database (NCT03293563), were pair-matched for tumor size, pathology, and RENAL score. The primary endpoint was the local recurrence rate between the two groups. Secondary endpoints included metastatic evolution, perioperative complications, decrease in renal function, and length of hospitalization.A total of 198 patients were included and matched into two groups of 72 patients. The local recurrence rate was significantly higher in the TA group than that in the 3D-IGRAPN group (4.2% vs. 15.2%, P=0.04). Metastatic evolution and perioperative outcomes such as major complications, eGFR decrease, and length of hospitalization did not differ significantly between the two groups.3D-IGRAPN resulted in a significantly lower local recurrence rate and comparable rates of complications and metastatic evolution compared with thermal ablation.