Radiofrequency ablation versus partial nephrectomy for treatment of renal masses: A systematic review and meta‐analysis

Abstract

Our study was to collect the data available in the literature on radiofrequency ablation (RFA) and partial nephrectomy (PN) and conduct a cumulative analysis on perioperative outcomes, renal function outcomes, and survival to evaluate the overall safety and efficacy of RFA versus PN for small renal cell cancer (SRCC). A literature search was carried out using various electronic databases. Data including age, tumor size, comorbid disease, operation duration, hospital stay, pre- and postoperative estimated glomerular filtration rate (eGFR), major and minor complications, and local tumor recurrence and metastasis were collected for meta-analysis. Sixteen studies were included for this meta-analysis. The age of patients treated with RFA was significantly older than that of patients treated with PN [weighted mean difference (WMD) = 5.07 years]. There were more patients with cardiovascular disease in RFA group as compared with PN group [odds ratio (OR) = 4.24] before treatment. RFA was associated with a shorter length of hospital stay compared with PN (WMD = -2.02 days). No significant difference was found in major and minor complications between the two groups (major: OR = 0.74; minor: OR = 0.45). Preoperative eGFR and eGFR decline in RFA patients was significantly lower than that in PN patients (WMD = -7.27 and -4.82, respectively), whereas there was no significant difference in postoperative eGFR (WMD = -1.18). The local tumor recurrence rate in RFA group was higher than that in PN group (OR = 1.81). However, the distant metastasis rate was no statistical difference between the two groups (OR = 1.63). RFA is a suitable therapeutic option for older patients and those at high risk for SRCC because of a low risk of operation and better preservation of renal function.

Ablation versus Resection for Stage 1A Renal Cell Carcinoma: National Variation in Clinical Management and Selected Outcomes

“…An interaction test between treatment and age was implemented to evaluate agedependent treatment effects. Patient age was dichotomized at 65 years for further subgroup analyses according to the mean age of patients who underwent thermal ablation in meta-analyses (16,17).…”

Trends in Percutaneous Thermal Ablation Therapies in the Treatment of T1a Renal Cell Carcinomas Rather than Partial Nephrectomy/Radical Nephrectomy

“…42 In a 2018 study, Uhlig et al evaluated 56,065 patients with T1a RCC undergoing TA (4,817, 8.6%) and PN/RN (51,248, 91.4%) with a median follow-up of 48 months and for the first postoperative year, survival was slightly higher for TA compared with nephrectomy (6-month survival for TA, 98.6%, vs. nephrectomy, 98.1%, p ¼ 0.015) with a small overall greater 5-year survival, in the nephrectomy cohort (82 vs. 76.4%, p ¼ 0.001) likely due to better unadjusted patient selection rather than differences in treatment efficacy. 52 In a 2019 study, Zhou et al reviewed 297 T1a biopsy-proven RCCs treated with CT-guided RFA (82%), cryoablation (26.9%), and MWA (27.9%) and reported similar TS rates among the three different treatments (p ¼ 0.33). 46 Although at 1 month postablation primary efficacy was more likely to be achieved with RF ablation and MWA than with cryoablation, no significant differences in therapeutic outcomes such as local recurrence, metastatic progression, or RCC-related death or renal function were found at 2 years of follow-up.…”

“…comparable therapeutic data to identify the potential efficacy differences among available multiple RCCs management modalities in long-term follow-up. 7,10,24,33,[42][43][44][45][46][47][48][49][50][51][52][53][54][55] In a 2019 study, Palumbo et al evaluated 3,946 patients using the Surveillance, Epidemiology and End Results database (SEER, 2004-2015) treated with cryosurgery for T1a lesions, reporting that tumor size greater than 3 cm is an independent predictor of higher 5-year cancer-specific mortality rate. Therefore, they suggested the local tumor ablation should be performed for tumors less than 3 cm.…”

“…44 Other studies have found no significant differences with regard to local recurrence rate or overall disease-free survival and distant metastases TA (RFA and MWA, excluding cryoablation) compared with PN. [47][48][49][50][51][52][53][54][55][56][57] Although some single-center studies have reported more local recurrences for TA compared with PN, 46,50 a recent AHRQ meta-analysis reported no significant difference in the risk ratio for local recurrence between PN and TA (RR: 1.21; 95% confidence interval: 0.58-2.5). 46…”

Organerhaltende Verfahren zur Therapie des Nierenzellkarzinoms

“…Die Komplikationen ähneln denen der RFA und werden in der Literatur mit 14-19 % der Fälle angegeben. Auch hier hängen sowohl das onkologische Ergebnis wie auch die Wahrscheinlichkeit von Komplikationen von der Größe des zu behandelnden Tumors ab [12].…”