Percutaneous Ablation Versus Nephrectomy for Small Renal Masses: Clinical Outcomes in a Single-Center Cohort
To compare the outcomes of percutaneous ablation (PA) versus nephrectomy (NE) for small renal masses (SRMs) in patients with T1 renal cell carcinoma and evaluate the role of pre-procedural biopsy in the treatment of SRM.
Materials and Methods
Retrospective cohort analysis of patients subjected to PA or NE for SRM (< 5 cm) from January 2006 to August 2016. A total of 231 patients with T1 SRM were included in the main analysis. Patient demographics, tumor characteristics, biopsy and procedural details, clinical outcomes, complication rates, and changes in renal function were compared in patients with malignant SRMs. Survival rates were compared using log-rank test.
A total of 142 patients underwent PA and 89 patients underwent NE, with a respective mean follow-up period of 2.50 (SD 1.77) and 1.85 (SD 0.97) years (P = 0.029). Rate of intervention for benign tumors was similar in PA (n = 21, 15%) and NE (n = 16, 18%; P = 0.520) without routine pre-procedural biopsy. Routine pre-procedural biopsy resulted in zero benign tumors treated in the PA cohort. Tumor recurrence was similar and cumulative survival was similar in both groups (P = 0.287). Residual tumor was observed in 18 PA patients. Complication rates were lower for PA than for NE (9 vs 30%, P < 0.001). A significant reduction in eGFR was observed after NE (12.1 mL/min/1.73 m2; P = 0.009) relative to PA (5.9 mL/min/1.73 m2; P = 0.060).
PA is a safe alternative to NE in the treatment of SRM, with similar overall survival and decreased complication rates. Pre-procedural biopsy decreases the rate of intervention for benign tumors and should be routinely performed.
KeywordsRenal cell carcinoma Small renal mass Percutaneous ablation Radiofrequency ablation Nephrectomy
Compliance with Ethical Standards
Conflict of interest
The authors declare that they have no conflict of interest.
This study has obtained IRB approval from the Fraser Health Research Ethics Board and the need for informed consent was waived.
- 4.Van Poppel H, Da Pozzo L, Albrecht W, Matveev V, Bono A, Borkowski A, et al. A prospective, randomised EORTC intergroup phase 3 study comparing the oncologic outcome of elective nephron-sparing surgery and radical nephrectomy for low-stage renal cell carcinoma. Eur Urol. 2011;59(4):543–52. https://doi.org/10.1016/j.eururo.2010.12.013.CrossRefPubMedGoogle Scholar
- 5.Gratzke C, Seitz M, Bayrle F, Schlenker B, Bastian PJ, Haseke N, et al. Quality of life and perioperative outcomes after retroperitoneoscopic radical nephrectomy (RN), open RN and nephron-sparing surgery in patients with renal cell carcinoma. BJU Int. 2009;104(4):470–5. https://doi.org/10.1111/j.1464-410X.2009.08439.x.CrossRefPubMedGoogle Scholar
- 6.Bensalah K, Zeltser I, Tuncel A, Cadeddu J, Lotan Y. Evaluation of costs and morbidity associated with laparoscopic radiofrequency ablation and laparoscopic partial nephrectomy for treating small renal tumours. BJU Int. 2008;101(4):467–71. https://doi.org/10.1111/j.1464-410X.2007.07276.x.CrossRefPubMedGoogle Scholar
- 7.Klatte T, Grubmuller B, Waldert M, Weibl P, Remzi M. Laparoscopic cryoablation versus partial nephrectomy for the treatment of small renal masses: systematic review and cumulative analysis of observational studies. Eur Urol. 2011;60(3):435–43. https://doi.org/10.1016/j.eururo.2011.05.002.CrossRefPubMedGoogle Scholar
- 11.Olweny EO, Park SK, Tan YK, Best SL, Trimmer C, Cadeddu JA. Radiofrequency ablation versus partial nephrectomy in patients with solitary clinical T1a renal cell carcinoma: comparable oncologic outcomes at a minimum of 5 years of follow-up. Eur Urol. 2012;61(6):1156–61. https://doi.org/10.1016/j.eururo.2012.01.001.CrossRefPubMedGoogle Scholar
- 13.Canter D, Kutikov A, Manley B, Egleston B, Simhan J, Smaldone M, et al. Utility of the RENAL nephrometry scoring system in objectifying treatment decision-making of the enhancing renal mass. Urology. 2011;78(5):1089–94. https://doi.org/10.1016/j.urology.2011.04.035.CrossRefPubMedPubMedCentralGoogle Scholar
- 18.Sevcenco S, Spick C, Helbich TH, Heinz G, Shariat SF, Klingler HC, et al. Malignancy rates and diagnostic performance of the Bosniak classification for the diagnosis of cystic renal lesions in computed tomography—a systematic review and meta-analysis. Eur Radiol. 2017;27(6):2239–47. https://doi.org/10.1007/s00330-016-4631-9.CrossRefPubMedGoogle Scholar