Ablative therapies versus partial nephrectomy for small renal masses – A systematic review and meta-analysis

Chan, Vinson Wai‐Shun; Abul, Ahmad; Osman, F.H.; Ng, Helen; Wang, Kaiwen; Yuan, Yuhong; Cartledge, Jon; Wah, Tze Min

doi:10.1016/j.ijsu.2021.106194

Cited by 33 publications

(39 citation statements)

References 39 publications

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“…The number of high-quality studies comparing the use of IGA and LPN is scarce, with most limited by extreme selection bias and short follow-up periods [ 3 , 24 ].…”

Section: Discussionmentioning

confidence: 99%

“…Percutaneous image-guided radio-frequency ablation (RFA) in SRMs was first reported in 1997 [ 2 ]. The adoption of image-guided ablation (IGA) has rapidly increased in the management of SRMs due to its minimally invasive nature and the theoretical ability to offer preservation of renal function and lower complication rate when compared to PN [ 3 ]. Other energy sources have been adopted to manage SRMs, including cryoablation (CRYO) [ 4 ], microwave ablation [ 5 ], and, more recently, irreversible electroporation [ 6 ].…”

Section: Introductionmentioning

confidence: 99%

“…The AUA guidelines also specify the importance of long follow-up periods (> 5 years) to accurately assess for late local recurrences. While there are some non-randomised evidence base to perform PN over radical nephrectomy, there is only one study by Andrews et al, showing comparable long-term oncological outcomes of IGA and LPN for SRMs for up to 5 years[ 3 , 9 ]. Chang et al, had also shown comparable 5-year outcomes between laparoscopic or imaged-guided RFA and PN [ 10 ].…”

Section: Introductionmentioning

confidence: 99%

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Long-term outcomes of image-guided ablation and laparoscopic partial nephrectomy for T1 renal cell carcinoma

et al. 2022

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Objective To compare long-term outcomes and peri-operative outcomes of image-guided ablation (IGA) and laparoscopic partial nephrectomy (LPN). Material and methods This is a retrospective cohort study of localised RCC (T1a/bN0M0) patients undergoing cryoablation (CRYO), radio-frequency ablation (RFA), or LPN at our institution from 2003 to 2016. Oncological outcomes were compared using Cox regression and log-rank analysis. eGFR changes were compared using Kruskal-Wallis and Wilcoxon-rank tests. Results A total of 296 (238 T1a, 58 T1b) consecutive patients were identified; 103, 100, and 93 patients underwent CRYO, RFA, and LPN, respectively. Median follow-up time was 75, 98, and 71 months, respectively. On univariate analysis, all oncological outcomes were comparable amongst CRYO, RFA, and LPN (p > 0.05). On multivariate analysis, T1a patients undergoing RFA had improved local recurrence-free survival (LRFS) (HR 0.002, 95% CI 0.00–0.11, p = 0.003) and metastasis-free survival (HR 0.002, 95% CI 0.00–0.52, p = 0.029) compared to LPN. In T1a and T1b patients combined, both CRYO (HR 0.07, 95% CI 0.01–0.73, p = 0.026) and RFA (HR 0.04, 95% CI 0.03–0.48, p = 0.011) had improved LRFS rates. Patients undergoing CRYO and RFA had a significantly smaller median decrease in eGFR post-operatively compared to LPN (T1a: p < 0.001; T1b: p = 0.047). Limitations include retrospective design and limited statistical power. Conclusions IGA is potentially as good as LPN in oncological durability. IGA preserves kidney function significantly better than LPN. More studies with larger sample size should be performed to establish IGA as a first-line treatment alongside LPN. Key Points • Ablative therapies are alternatives to partial nephrectomy for managing small renal cell carcinomas. • This study reports long-term outcomes of image-guided ablation versus partial nephrectomy. • Ablative therapies have comparable oncological durability and better renal function preservation compared to partial nephrectomy.

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“…The number of high-quality studies comparing the use of IGA and LPN is scarce, with most limited by extreme selection bias and short follow-up periods [ 3 , 24 ].…”

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Long-term outcomes of image-guided ablation and laparoscopic partial nephrectomy for T1 renal cell carcinoma

et al. 2022

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“…Different diagnostic tools may be employed, alone or in association [ 62 , 63 , 64 , 65 , 66 , 67 , 68 , 69 , 70 , 71 , 72 , 73 ]. Computed tomography (CT) and magnetic resonance imaging (MRI) represent the traditional imaging tools employed during the pre-treatment phase in order to identify and assess the target area [ 74 , 75 , 76 , 77 , 78 , 79 , 80 , 81 , 82 , 83 , 84 , 85 , 86 ], and in surveillance of the patient to evaluate treatment efficacy and post-procedural complications [ 87 , 88 , 89 , 90 , 91 , 92 , 93 ]. Ultrasound examination (US), without or with contrast medium (CEUS), is an innovative tool, utilized for problem solving during pre- and post-treatment phases [ 94 , 95 , 96 , 97 , 98 , 99 , 100 , 101 , 102 , 103 , 104 ], although the main use of interest is the possibility of assessing immediate effects during the procedure [ 60 , 61 ].…”

Section: Imaging and Ablation Treatmentmentioning

confidence: 99%

Complications Risk Assessment and Imaging Findings of Thermal Ablation Treatment in Liver Cancers: What the Radiologist Should Expect

Granata

Fusco

Muzio

et al. 2022

JCM

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One of the major fields of application of ablation treatment is liver tumors. With respect to HCC, ablation treatments are considered as upfront treatments in patients with early-stage disease, while in colorectal liver metastases (CLM), they can be employed as an upfront treatment or in association with surgical resection. The main prognostic feature of ablation is the tumor size, since the goal of the treatment is the necrosis of all viable tumor tissue with an adequate tumor-free margin. Radiofrequency ablation (RFA) and microwave ablation (MWA) are the most employed ablation techniques. Ablation therapies in HCC and liver metastases have presented a challenge to radiologists, who need to assess response to determine complication-related treatment. Complications, defined as any unexpected variation from a procedural course, and adverse events, defined as any actual or potential injury related to the treatment, could occur either during the procedure or afterwards. To date, RFA and MWA have shown no statistically significant differences in mortality rates or major or minor complications. To reduce the rate of major complications, patient selection and risk assessment are essential. To determine the right cost-benefit ratio for the ablation method to be used, it is necessary to identify patients at high risk of infections, coagulation disorders and previous abdominal surgery interventions. Based on risk assessment, during the procedure as part of surveillance, the radiologists should pay attention to several complications, such as vascular, biliary, mechanical and infectious. Multiphase CT is an imaging tool chosen in emergency settings. The radiologist should report technical success, treatment efficacy, and complications. The complications should be assessed according to well-defined classification systems, and these complications should be categorized consistently according to severity and time of occurrence.

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“…Therefore, the comparative study on MIPN and FT is very meaningful. However, there are main systematic reviews about ablative therapies versus partial nephrectomy for small renal masses at present ( 8 ). Therefore, the purpose of this study is to compare the perioperative period, renal function, and oncologic outcomes of MIPN and FT in SRMs.…”

Section: Introductionmentioning

confidence: 99%

A Systematic Review and Meta-Analysis of Minimally Invasive Partial Nephrectomy Versus Focal Therapy for Small Renal Masses

Dong¹,

Liang²,

Ya³

et al. 2022

Front. Oncol.

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BackgroundMinimally invasive partial nephrectomy (MIPN) and focal therapy (FT) are popular trends for small renal masses (SRMs). However, there is currently no systematic comparison between MIPN and FT of SRMs. Therefore, we systematically study the perioperative, renal functional, and oncologic outcomes of MIPN and FT in SRMs.MethodsWe have searched the Embase, Cochrane Library, and PubMed for articles between MIPN (robot-assisted partial nephrectomy and laparoscopic partial nephrectomy) and FT {radiofrequency ablation (RFA), microwave ablation (MWA), cryoablation (CA), irreversible electroporation, non-thermal [irreversible electroporation (IRE)] ablation, and stereotactic body radiation therapy (SBRT)}. We calculated pooled mean difference (MD), odds ratios (ORs), and 95% confidence intervals (CIs) (CRD42021260787).ResultsA total of 26 articles (n = 4,420) were included in the study. Compared with MIPN, the operating time (OP) of FT had significantly lower (SMD, −1.20; CI, −1.77 to −0.63; I2 = 97.6%, P < 0.0001), estimated blood loss (EBL) of FT had significantly less (SMD, −1.20; CI, −1.77 to −0.63; I2 = 97.6%, P < 0.0001), length of stay (LOS) had shorter (SMD, −0.90; CI, −1.26 to −0.53; I2 = 92.2%, P < 0.0001), and estimated glomerular filtration rate (eGFR) of FT was significantly lower decrease (SMD, −0.90; CI, −1.26 to −0.53; I2 = 92.2%, P < 0.0001). However, FT possessed lower risk in minor complications (Clavien 1–2) (OR, 0.69; CI, 0.45 to 1.07; I2 = 47%, P = 0.023) and overall complications (OR, 0.71; CI, 0.51 to 0.99; I2 = 49.2%, P = 0.008). Finally, there are no obvious difference between FT and MIPN in local recurrence, distant metastasis, and major complications (P > 0.05).ConclusionFT has more advantages in protecting kidney function, reducing bleeding, shortening operating time, and shortening the length of stay. There is no difference in local recurrence, distant metastasis, and major complications. For the minimally invasive era, we need to weigh the advantages and disadvantages of all aspects to make comprehensive choices.Systematic Review Registrationhttps://www.crd.york.ac.uk/PROSPERO/#recordDetails, identifier PROSPERO (CRD42021260787).

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Ablative therapies versus partial nephrectomy for small renal masses – A systematic review and meta-analysis

Cited by 33 publications

References 39 publications

Long-term outcomes of image-guided ablation and laparoscopic partial nephrectomy for T1 renal cell carcinoma

Long-term outcomes of image-guided ablation and laparoscopic partial nephrectomy for T1 renal cell carcinoma

Complications Risk Assessment and Imaging Findings of Thermal Ablation Treatment in Liver Cancers: What the Radiologist Should Expect

A Systematic Review and Meta-Analysis of Minimally Invasive Partial Nephrectomy Versus Focal Therapy for Small Renal Masses

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