Percutaneous Microwave Ablation versus Laparoscopic Partial Nephrectomy for cT1a Renal Cell Carcinoma: A Propensity-matched Cohort Study of 1955 Patients

Abstract

VASCULAR AND INTERVENTIONAL RADIOLOGYR enal cell carcinoma (RCC) is a heterogeneous group of kidney cancers mostly of proximal tubule origin (1) and represents more than 90% of all kidney cancers (2). The global yearly incidence of RCC is estimated at six per 100 000 men and three per 100 000 women (3). Patients with T1a RCC are considered to have a good prognosis, with a frequency of distant metastasis of 0.7%-7.2% (4).Current treatment guidelines recommend partial nephrectomy as the preferred treatment for patients with clinical T1a (ie, cT1a) RCC and who are good surgical candidates (5). Thermal ablation is an appropriate option for elderly patients with comorbidities who are unfit for surgery, mainly because of the benefit of renal preservation and minimal invasion (6-8). Indeed, several studies have concluded that the oncologic control was similar between partial nephrectomy and cryoablation or radiofrequency ablation (RFA) (9-13). Microwave ablation (MWA) is one of the most recent and exciting advances among thermal ablation techniques and has been widely used for the treatment of hepatocellular carcinoma (14). Compared with the passive heating of RFA, the potential benefits of MWA include a larger ablation zone and higher intratumoral temperatures achieved through active heating (15). Therefore, MWA offers optimistic outcomes for small RCC (16)(17)(18). Previous studies by our group concluded that the oncologic outcomes with percutaneous MWA were comparable to those with radial nephrectomy (19,20). A study comparing open or laparoscopic MWA with open partial nephrectomy showed that the two modalities achieved similar results (21).Percutaneous MWA and laparoscopic partial nephrectomy (LPN) are two modalities indicated for early-stage

Long-Term Follow-Up Outcomes after Percutaneous US/CT-Guided Radiofrequency Ablation for cT1a-b Renal Masses: Experience from Single High-Volume Referral Center

“…In this setting, the need of multiple treatments is generally accepted and taken into account during multidisciplinary discussions when establishing the patient treatment strategy. In fact, with a second ablation complete tumor ablation can be achieved in the large majority of cases [30,31,34]. Furthermore, patients can have a local tumor progression during follow-up, develop new foci of renal tumors in the same or in the contralateral kidney, or distant metastases.…”

“…Furthermore, patients can have a local tumor progression during follow-up, develop new foci of renal tumors in the same or in the contralateral kidney, or distant metastases. In all these scenarios, image-guided thermal ablation can be applied to achieve disease control [30,[33][34][35][36]. Thus, it might easily occur that a patient requires multiple ablations over the course of his disease.…”

Simultaneous Living Donor Kidney Transplant and Laparoscopic Native Nephrectomy: An Approach to Kidney Transplant Candidates with Suspected Renal-Cell Carcinoma

“…Besides nephrectomy, an alternative treatment approach for patients with small, incidentally detected RCC is radiofrequency ablation or cryoablation. 17,18 Ablation may be considered for selected patients with masses <4 cm who are poor surgical candidates or who require nephron-sparing treatment of their masses. While ablation was discussed preoperatively with our patients, the decision was made to proceed with resection as both diagnosis and treatment of the lesion, while minimizing the need for long-term surveillance, and given the limited role for preserving native renal function in the setting of ESRD.…”

Percutaneous microwave ablation of renal cell carcinoma: practice guidelines of the ultrasound committee of Chinese medical association, interventional oncology committee of Chinese research hospital association

“…In terms of major complications, a 1.8% of meta-analytic pooled incidence was found (15). Study with the largest number of patients is reported in the single-center retrospective series from Liang et al in China ( [59], LoE 4). The authors included 185 patients with 192 sporadic T1a RCCs that were treated with US-guided percutaneous MWA.…”

“…The largest sample report on CT-guided percutaneous MWA of RCC is from Wells et al in USA ( [51], LoE 4), which showed the LTP rate was 1% (1/100) and 3-year OS was 91%. By now four reports have compared surgery and MWA in RCC patients with comparative oncologic survival outcomes ( [27,42,59,60], LoE 3). In addition, MWA has also been compared with cryoablation and RFA in treating small RCC from case control study.…”