Standard of Care and New Operative Techniques for Small Renal Tumors: a Meta-analysis with a Special Focus on Cryoablation

Abstract

Introduction: the aim of this article is to realize a meta-analysis of published data evaluating open nephrectomy, laparoscopic nephrectomy and cryoablation for small renal masses to define the current data, and to adjust oncological results for patients and follow-up heterogeneity by performing econometric estimations.Materials and methods: a systematic literature review using the STROBE checklist was performed for clinically localized sporadic renal masses from the beginning of January 1996 until October 31, 2008. The main variables evaluated were patients' age and sex, tumor size, ASA score, duration of follow-up, available clinical outcomes, pathological data, and oncological outcomes.Results: 152 studies representing 19 994 patients were analyzed. The authors found a significant lower operation time for percutaneous cryoablation, and a lower hospital stay and blood losses for all types of cryoablation (i.e. open, laparoscopic and percutaneous). No significant difference is found between cryoablation and resection methods as regard to complication rates. When adjusting oncological results for patients and follow-up heterogeneity, higher recurrence rates at five years are found for cryoablation, on the contrary, no difference is found for specific-cancer survival rates at five years.Conclusions: cryoablation is a safe and less invasive procedure than resection methods. However, its long term efficacy has not yet been established and a more stringent selection of patients is needed to reduce recurrence rates.