Percutaneous thermal ablation for cT1 renal mass in solitary kidney: A multicenter trifecta comparative analysis versus robot-assisted partial nephrectomy

Pandolfo, Savio Domenico; Loizzo, Davide; Beksaç, Alp Tuna; Derweesh, Ithaar; Celia, Antonio; Bianchi, Lorenzo; Elbich, Jeffrey; Costa, Giovanni; Carbonara, Umberto; Lucarelli, Giuseppe; Cerrato, Clara; Meagher, Margaret; Ditonno, Pasquale; Hampton, Lance J.; Basile, Giuseppe; Kim, Fernando J.; Schiavina, Riccardo; Capitanio, Umberto; Kaouk, Jihad; Autorino, Riccardo

doi:10.1016/j.ejso.2022.09.022

Cited by 29 publications

(17 citation statements)

References 30 publications

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“…It must be stressed that percutaneous RFA is a minimally invasive treatment and can in certain cases be performed under local anaesthesia [8,13]. It is associated with shorter hospital stay than NSS (even robotic) and low complication rate, even in more challenging scenarios, such as endophytic tumour or tumour in single kidney [9,25,26].…”

Section: Discussionmentioning

confidence: 99%

Ultrasound-Guided Percutaneous Thermal Ablation of Renal Cancers—In Search for the Ideal Tumour

Jasiński

Bielinska

Siekiera

et al. 2023

Cancers

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Over the recent years, the progress in imaging techniques has led to an increased detection of kidney tumours, including small renal masses. While surgery is still the standard of care, there is a growing interest in minimally invasive methods. Ultrasound (US)-guided percutaneous ablation is particularly attractive because it is a safe and relatively simple procedure. In this study, we investigated the success of percutaneous radiofrequency ablation (RFA) in relation to kidney tumour diameter and location. Between August 2016 and September 2021, 253 patients with 259 renal tumours underwent US-guided RFA as a primary treatment in our institution. A total of 67 patients were excluded from this study. Abdominal computed tomography (CT) and tumour biopsy were performed before the procedure. Patients were followed with contrast-enhanced CT, the average follow-up time was 28 months. The studied group was composed of 186 patients with 191 renal tumours—only biopsy-confirmed renal cancers were included. During the follow-up, 46 cases of residual disease and 4 cases of local progression were found. There was a significant correlation between tumour size and the ablation success rate. The success rate was 73.5% and 87.6% for lesions ≤25 mm, 94.6% for lesions ≤25 mm and exophytic, 79.1% for lesions 26–30 mm and 84.4% for lesions 26–30 mm and exophytic, respectively. Four Clavien-Dindo grade ≥2 complications were observed. US-guided percutaneous RFA of T1a renal cancers is safe and well-tolerated. Its effectiveness depends on tumour size, with best results for exophytic lesions smaller than 3 cm. Most of the recurrent or residual tumours can be successfully re-treated with US-guided percutaneous RFA.

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Section: Discussionmentioning

confidence: 99%

Ultrasound-Guided Percutaneous Thermal Ablation of Renal Cancers—In Search for the Ideal Tumour

Jasiński

Bielinska

Siekiera

et al. 2023

Cancers

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“…Practically speaking, clinical translation of adjuvant localized IL-12 might be most efficient in solid cancers for which CA is already used, such as kidney, prostate, breast, lung and bone cancers. As an example, adjuvant CS/IL-12 could be explored in larger (>4 cm) renal masses for which CA is not recommended due to higher recurrence rates compared to partial nephrectomy [ 20 ].…”

Section: Discussionmentioning

confidence: 99%

“…CA of hepatocellular carcinomas (HCCs) results in 20% local and 60% distant recurrences [ 19 ]. Against the small T1a renal cell carcinomas, clinical outcomes following CA and partial nephrectomy are similar [ 20 , 21 , 22 , 23 , 24 , 25 , 26 ]. However, when renal tumors exceed 4 cm, CA results in inferior recurrence rates [ 27 , 28 ].…”

Section: Introductionmentioning

confidence: 99%

Focal Cryo-Immunotherapy with Intratumoral IL-12 Prevents Recurrence of Large Murine Tumors

Vrabel

Schulman

Gillam

et al. 2023

Cancers

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Focal ablation technologies are routinely used in the clinical management of inoperable solid tumors but they often result in incomplete ablations leading to high recurrence rates. Adjuvant therapies, capable of safely eliminating residual tumor cells, are therefore of great clinical interest. Interleukin-12 (IL-12) is a potent antitumor cytokine that can be localized intratumorally through coformulation with viscous biopolymers, including chitosan (CS) solutions. The objective of this research was to determine if localized immunotherapy with a CS/IL-12 formulation could prevent tumor recurrence after cryoablation (CA). Tumor recurrence and overall survival rates were assessed. Systemic immunity was evaluated in spontaneously metastatic and bilateral tumor models. Temporal bulk RNA sequencing was performed on tumor and draining lymph node (dLN) samples. In multiple murine tumor models, the addition of CS/IL-12 to CA reduced recurrence rates by 30–55%. Altogether, this cryo-immunotherapy induced complete durable regression of large tumors in 80–100% of treated animals. Additionally, CS/IL-12 prevented lung metastases when delivered as a neoadjuvant to CA. However, CA plus CS/IL-12 had minimal antitumor activity against established, untreated abscopal tumors. Adjuvant anti-PD-1 therapy delayed the growth of abscopal tumors. Transcriptome analyses revealed early immunological changes in the dLN, followed by a significant increase in gene expression associated with immune suppression and regulation. Cryo-immunotherapy with localized CS/IL-12 reduces recurrences and enhances the elimination of large primary tumors. This focal combination therapy also induces significant but limited systemic antitumor immunity.

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“…In recent years, numerous studies have been published attempting to explore whether TA is an effective and safe alternative for the treatment of SRMs in solitary kidneys. However, the results have been inconsistent [17][18][19][20][21][22][23][24][25][26][27][28][29] . Additionally, the sample size at single centers was small, and no credible conclusions could be drawn.…”

Section: Introductionmentioning

confidence: 99%

Perioperative, functional, and oncologic outcomes after ablation or partial nephrectomy for solitary renal tumors: a systematic review and meta-analysis of comparative trials

Wen

Wang

Huang

et al. 2023

Preprint

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Objectives The perioperative, functional, and oncological outcomes of patients with solitary small renal tumors(SRMs) treated with ablation(AT) or partial nephrectomy(PN) remain controversial. The aim of this study was to compare the outcomes of these two surgical techniques. Methods In April 2023, we conducted a literature search in several widely used databases worldwide, including PubMed, Embase, and Google Scholar. Review Manager was used to compare various parameters. The study was registered with PROSPERO (CRD42022377157). Results Our final meta-analysis included 13 cohort studies with a total of 2,107 patients. Compared to partial nephrectomy (PN), ablation (AT) had shorter hospital stays (WMD − 2.37 days, 95% CI -3.05 to -1.69; p < 0.00001), shorter operating times (WMD − 57.06 min, 95% CI -88.92 to -25.19; p = 0.0004), less postoperative creatinine increases (WMD − 0.17 mg/dL, 95% CI -0.29 to -0.05; p = 0.006), less postoperative glomerular filtration rate decreases (WMD − 9.84 mL/min/1.73 m2, 95% CI -14.25 to -5.44; p < 0.0001), less postoperative new-onset chronic kidney disease (OR 0.33, 95% CI 0.16 to 0.71; p = 0.005), and less intraoperative blood loss (WMD − 285.92 ml, 95% CI -428.44 to -143.40; p < 0.0001). The transfusion rate was lower in the ablation group (OR 0.17, 95% CI 0.06 to 0.51; p = 0.001). The risk of local recurrence was higher in the ablation group (OR 2.96, 95% CI 1.27 to 6.89; p = 0.01), while the risk of distant metastasis was higher in the partial nephrectomy group (OR 2.81, 95% CI 1.28 to 6.18; p = 0.01). The intraoperative and postoperative complication rates were lower in the ablation group (OR 0.23, 95% CI 0.08 to 0.62; p = 0.004 and OR 0.21, 95% CI 0.11 to 0.38; p < 0.00001, respectively). However, overall survival, postoperative dialysis rate, and tumor-specific survival were not different between the two groups. Conclusions Our data suggest that ablation and partial nephrectomy are equally safe and effective in the treatment of small solitary kidney tumors and are better options for patients with poor preoperative physical condition or poor renal function.

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Percutaneous thermal ablation for cT1 renal mass in solitary kidney: A multicenter trifecta comparative analysis versus robot-assisted partial nephrectomy

Cited by 29 publications

References 30 publications

Ultrasound-Guided Percutaneous Thermal Ablation of Renal Cancers—In Search for the Ideal Tumour

Ultrasound-Guided Percutaneous Thermal Ablation of Renal Cancers—In Search for the Ideal Tumour

Focal Cryo-Immunotherapy with Intratumoral IL-12 Prevents Recurrence of Large Murine Tumors

Perioperative, functional, and oncologic outcomes after ablation or partial nephrectomy for solitary renal tumors: a systematic review and meta-analysis of comparative trials

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