Cryoablation versus Partial Nephrectomy for Clinical Stage T1 Renal Masses: A Systematic Review and Meta-Analysis

Abstract

Introduction : Cryoablation has been considered as the most efficacious ablative alternative to partial nephrectomy (PN) for selected patients. Our objective is to assess the existing evidence relating to the safety and efficacy of cryoablation compared with PN for clinical T1 renal masses. Materials and Methods : A comprehensive search of PMC, EMBASE, and the Cochrane Library was conducted to identify studies containing comparison of cryoablation and PN. By utilizing those included studies, a systematic review and cumulative meta-analyses were performed to assess the safety and efficacy between cryoablation and PN for T1 renal masses. Results : 17 retrospective studies providing available data were included in our study. Significant differences were found about all oncological variables including all-cause death, cancer-specific death, metastasis and local-recurrence (p < 0.001, p = 0.03, p < 0.001, and p < 0.001, respectively) between the PN group and the cryoablation group. The mean difference between two groups for percent estimated glomerular filtration rate decrease and creatinine increase was -4.84 and 0.15 respectively (p < 0.001 and p = 0.006, respectively). The incidences of overall and postoperative complications in the PN group were significantly higher than that in the cryoablation group (p = 0.001 and p < 0.001, respectively), but the result about intraoperative complications didn't show a significant difference between the two groups (p = 0.53). Conclusions : Comparing with PN, cryoablation for clinical T1 renal tumors is associated with poorer oncological outcomes, but the existing disadvantages are accompanied by lower rate of overall and postoperative complications and superior renal functional preservation. For patients with imperative indications for nephron-sparing surgery who can't risk more invasive PN, cryoablation could be an attractive option. Owing to the inherent limitations of eligible studies, conclusions drawn from our meta-analyses should be interpreted cautiously and be confirmed further with well-designed randomized controlled trials with extensive follow-up length.

Validation of a Web-Based Planning Tool for Percutaneous Cryoablation of Renal Tumors

“…Despite the availability of larger studies with recurrence-free survival exceeding 85% after longer follow-up, long-term oncological outcomes for percutaneous cryoablation are under debate [ 3 – 5 ]. Two recent meta-analyses suggest higher local recurrence rates for cryoablation compared to partial nephrectomy; whereas, more recent studies show that cryoablation challenges partial nephrectomy for local control of cT1a renal tumors [ 6 – 8 ].…”

Zalecenia Postępowania Diagnostyczno-Terapeutycznego W Raku Nerkowokomórkowym

“…The results of studies comparing nephron sparing surgery (NSS) performed by different techniques (open, laparoscopic or robot-assisted) with CA of kidney tumor (percutaneous or laparoscopic technique) are inconclusive. Some of them show no differences in overall survival (OS), cancer specific survival (CSS), recurrence-free survival (RFS) and disease-free survival (DFS), local recurrence rate of progression to metastatic disease [34,35], while others demonstrate the advantage of NSS [36,37]. Importantly, none of the published studies indicates a prognostic advantage of CA over NSS.…”

Percutaneous Cryoablation of Renal Tumors: Initial Indian Experience

“…7 Because of this, cryoablation is preferred whenever it is imperative to preserve renal function, such as in solitary kidney, multiple synchronous renal cell carcinoma (RCC), von Hippel-Lindau disease, familial RCC, or those with limited renal function. 7 11 While popular in the western countries, the use of cryoablation for renal tumors has not been reported in India. The purpose of this study was to report short-term outcomes of cryoablation of early-stage renal tumors (T1a and T1b) at a tertiary hospital in India.…”