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European Radiology

, Volume 29, Issue 3, pp 1293–1307 | Cite as

Partial nephrectomy versus ablative techniques for small renal masses: a systematic review and network meta-analysis

  • Johannes Uhlig
  • Arne Strauss
  • Gerta Rücker
  • Ali Seif Amir Hosseini
  • Joachim Lotz
  • Lutz Trojan
  • Hyun S. Kim
  • Annemarie UhligEmail author
Interventional
  • 238 Downloads

Abstract

Purpose

To compare partial nephrectomy (PN), radiofrequency ablation (RFA), cryoablation (CRA) and microwave ablation (MWA) regarding oncologic, perioperative and functional outcomes.

Material and methods

The MEDLINE, EMBASE and COCHRANE libraries were searched for studies comparing PN, RFA, CRA or MWA and reporting on any-cause or cancer-specific mortality, local recurrence, complications or renal function. Network meta-analyses were performed.

Results

Forty-seven studies with 24,077 patients were included. Patients receiving RFA, CRA or MWA were older and had more comorbidities compared with PN. All-cause mortality was higher for CRA and RFA compared with PN (incidence rate ratio IRR = 2.58, IRR = 2.58, p < 0.001, respectively). No significant differences in cancer-specific mortality were evident. Local recurrence was higher for CRA, RFA and MWA compared with PN (IRR = 4.13, IRR = 1.79, IRR = 2.52, p < 0.05 respectively). A decline in renal function was less pronounced after RFA versus PN, CRA and MWA (mean difference in GFR MD = 6.49; MD = 5.82; MD = 10.89, p < 0.05 respectively).

Conclusion

Higher overall survival and local control of PN compared with ablative therapies did not translate into significantly better cancer-specific mortality. Most studies carried a high risk of bias by selecting younger and healthier patients for PN, which may drive superior survival and local control. Physicians should be aware of the lack of high-quality evidence and the potential benefits of ablative techniques for certain patients, including a superior complication profile and renal function preservation.

Key Points

• Patients selected for ablation of small renal masses are older and have more comorbidities compared with those undergoing partial nephrectomy.

• Partial nephrectomy yields lower all-cause mortality, which is probably biased by patient selection and does not translate into prolonged cancer-free survival.

• The decline of renal function is smallest after radiofrequency ablation for small renal masses.

Keywords

Kidney neoplasms Ablation techniques Nephrectomy Meta-analysis 

Abbreviations

CRA

Cryoablation

GFR

Glomerular filtration rate

IRR

Incidence rate ratio

MWA

Microwave ablation

PN

Partial nephrectomy

RFA

Radiofrequency ablation

Notes

Funding

Annemarie Uhlig’s work was supported by a Ferdinand Eisenberger Grant of the Deutsche Gesellschaft für Urologie (German Society of Urology), grant ID UhA1/FE-17.

Compliance with ethical standards

Guarantor

The scientific guarantor of this publication is Annemarie Uhlig.

Conflict of interest

The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article.

Statistics and biometry

Three of the authors have significant statistical expertise.

Informed consent

Written informed consent was not required for this study because of the meta-analysis study design.

Ethical approval

Institutional Review Board approval was not required because of the meta-analysis study design.

Study subjects or cohorts overlap

Study subjects or cohorts have been previously reported as detailed in the references.

Methodology

• observational

Supplementary material

330_2018_5660_MOESM1_ESM.docx (1.2 mb)
ESM 1 (DOCX 1226 kb)

References

  1. 1.
    Znaor A, Lortet-Tieulent J, Laversanne M, Jemal A, Bray F (2015) International variations and trends in renal cell carcinoma incidence and mortality. Eur Urol 67:519–530CrossRefGoogle Scholar
  2. 2.
    Luciani LG, Cestari R, Tallarigo C (2000) Incidental renal cell carcinoma-age and stage characterization and clinical implications: study of 1092 patients (1982-1997). Urology 56:58–62CrossRefGoogle Scholar
  3. 3.
    Ljungberg B, Bensalah K, Canfield S et al (2015) EAU guidelines on renal cell carcinoma: 2014 update. Eur Urol 67:913–924Google Scholar
  4. 4.
    Campbell S, Uzzo RG, Allaf ME et al (2017) Renal Mass and Localized Renal Cancer: AUA Guideline. J Urol 198:520–529Google Scholar
  5. 5.
    Higgins LJ, Hong K (2015) Renal ablation techniques: state of the art. AJR Am J Roentgenol 205:735–741CrossRefGoogle Scholar
  6. 6.
    Katsanos K, Mailli L, Krokidis M, McGrath A, Sabharwal T, Adam A (2014) Systematic review and meta-analysis of thermal ablation versus surgical nephrectomy for small renal tumours. Cardiovasc Intervent Radiol 37:427–437CrossRefGoogle Scholar
  7. 7.
    Patel HD, Pierorazio PM, Johnson MH et al (2017) Renal functional outcomes after surgery, ablation, and active surveillance of localized renal tumors: a systematic review and meta-analysis. Clin J Am Soc Nephrol 12:1057-1069Google Scholar
  8. 8.
    Klatte T, Shariat SF, Remzi M (2014) Systematic review and meta-analysis of perioperative and oncologic outcomes of laparoscopic cryoablation versus laparoscopic partial nephrectomy for the treatment of small renal tumors. J Urol 191:1209–1217CrossRefGoogle Scholar
  9. 9.
    Hutton B, Salanti G, Caldwell DM et al (2015) The PRISMA extension statement for reporting of systematic reviews incorporating network meta-analyses of health care interventions: Checklist and explanations. Ann Intern Med 162:777-784Google Scholar
  10. 10.
    Caldwell DM, Ades AE, Higgins JP (2005) Simultaneous comparison of multiple treatments: combining direct and indirect evidence. BMJ 331:897–900CrossRefGoogle Scholar
  11. 11.
    Mills EJ, Thorlund K, Ioannidis JP (2013) Demystifying trial networks and network meta-analysis. BMJ 346Google Scholar
  12. 12.
    Rothman KJ, Greenland S, Lash TL (2008) Modern epidemiology, 3rd edn. Wolters Kluwer Health/Lippincott Williams & Wilkins, PhiladelphiaGoogle Scholar
  13. 13.
    Deeks JJ, Dinnes J, D'Amico R et al (2003) Evaluating non-randomised intervention studies. Health Technol Assess 7:iii-x, 1-173Google Scholar
  14. 14.
    Downs SH, Black N (1998) The feasibility of creating a checklist for the assessment of the methodological quality both of randomised and non-randomised studies of health care interventions. J Epidemiol Community Health 52:377–384CrossRefGoogle Scholar
  15. 15.
    Higgins J, Green S (2011) Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0 [updated March 2011]. The Cochrane CollaborationGoogle Scholar
  16. 16.
    Rücker G (2012) Network meta-analysis, electrical networks and graph theory. Res Synth Methods 3:312–324CrossRefGoogle Scholar
  17. 17.
    Higgins JP, Thompson SG (2002) Quantifying heterogeneity in a meta-analysis. Stat Med 21:1539–1558CrossRefGoogle Scholar
  18. 18.
    Krahn U, Binder H, König J (2014) Visualizing inconsistency in network meta-analysis by independent path decomposition. BMC Med Res Methodol 14:131CrossRefGoogle Scholar
  19. 19.
    Rücker G, Schwarzer G (2015) Ranking treatments in frequentist network meta-analysis works without resampling methods. BMC Med Res Methodol 15:58CrossRefGoogle Scholar
  20. 20.
    R Development Core Team (2008) R: A language and environment for statistical computing. R Foundation for Statistical Computing, https://www.r-project.org, Vienna, Austria
  21. 21.
    RStudio Team (2015) RStudio: Integrated Development for R, Boston, MA, USA, https://www.rstudio.com
  22. 22.
    Schwarzer G (2007) meta: An R package for meta-analysis. R News 7:40–45Google Scholar
  23. 23.
    Rücker G, Schwarzer G, Krahn U, König J (2017) netmeta: Network Meta-Analysis using Frequentist Methods, https://CRAN.R-project.org/package=netmeta
  24. 24.
    Abboud SE, Patel T, Soriano S, Giesler J, Alvarado N, Kang P (2017) Long-Term Clinical Outcomes Following Radiofrequency and Microwave Ablation of Renal Cell Carcinoma at a Single VA Medical Center. Curr Probl Diagn Radiol.  https://doi.org/10.1067/j.cpradiol.2017.05.006
  25. 25.
    Alekseev B, Kalpinskiy A, Nyushko K et al (2017) Better nephron sparing option for patients with cT1 stage renal masses: Comparison of open, laparoscopic partial nephrectomy and radiofrequency ablation. Eur Urol, Supplements 16 (3):e632-e633Google Scholar
  26. 26.
    Arnoux V, Descotes JL, Sengel C, Terrier N, Rambeaud JJ, Long JA (2013) Perioperative outcomes and mid-term results of radiofrequency ablation and partial nephrectomy in indications of renal tumor treatment and imperative nephron-sparing procedure. Prog Urol 23:99–104CrossRefGoogle Scholar
  27. 27.
    Atwell TD, Schmit GD, Boorjian SA et al (2013) Percutaneous ablation of renal masses measuring 3.0 cm and smaller: comparative local control and complications after radiofrequency ablation and cryoablation. AJR Am J Roentgenol 200:461–466CrossRefGoogle Scholar
  28. 28.
    Bensalah K, Zeltser I, Tuncel A, Cadeddu J, Lotan Y (2008) Evaluation of costs and morbidity associated with laparoscopic radiofrequency ablation and laparoscopic partial nephrectomy for treating small renal tumours. BJU Int 101:467–471Google Scholar
  29. 29.
    Bhindi B, Mason RJ, Haddad MM et al (2017) Outcomes after cryoablation versus partial nephrectomy for sporadic renal tumors in a solitary kidney: a propensity score analysis. Eur Urol.  https://doi.org/10.1016/j.eururo.2017.09.009
  30. 30.
    Bird VG, Carey RI, Ayyathurai R, Bird VY (2009) Management of renal masses with laparoscopic-guided radiofrequency ablation versus laparoscopic partial nephrectomy. J Endourol 23:81–88CrossRefGoogle Scholar
  31. 31.
    Camacho JC, Kokabi N, Small WC, Kies D, Kim HS (2016) Radiofrequency ablation (RFA) vs. Cryoablation (Cryo) vs. Microwave ablation (MCW) of T1 renal cell carcinomas (RCC): Outcome prediction in an intermediate-long term cohort. Journal of Vascular and Interventional Radiology 27(6):e68.  https://doi.org/10.1016/j.jvir.2016.04.006
  32. 32.
    Caputo PA, Zargar H, Ramirez D et al (2017) Cryoablation versus Partial Nephrectomy for Clinical T1b Renal Tumors: A Matched Group Comparative Analysis. Eur Urol 71:111–117CrossRefGoogle Scholar
  33. 33.
    Chang X, Liu T, Zhang F et al (2015) Radiofrequency ablation versus partial nephrectomy for clinical T1a renal-cell carcinoma: long-term clinical and oncologic outcomes based on a propensity score analysis. J Endourol 29:518–525CrossRefGoogle Scholar
  34. 34.
    Chang X, Zhang F, Liu T et al (2015) Radio frequency ablation versus partial nephrectomy for clinical T1b renal cell carcinoma: long-term clinical and oncologic outcomes. J Urol 193:430–435CrossRefGoogle Scholar
  35. 35.
    Chehab M, Friedlander JA, Handel J et al (2016) Percutaneous Cryoablation vs Partial Nephrectomy: Cost Comparison of T1a Tumors. J Endourol 30:170–176CrossRefGoogle Scholar
  36. 36.
    Cooper CJ, Teleb M, Dwivedi A et al (2015) Comparative Outcome of Computed Tomography-guided Percutaneous Radiofrequency Ablation, Partial Nephrectomy or Radical Nephrectomy in the Treatment of Stage T1 Renal Cell Carcinoma. Rare Tumors 7:5583CrossRefGoogle Scholar
  37. 37.
    Danzig MR, Ghandour RA, Chang P et al (2015) Active Surveillance is Superior to Radical Nephrectomy and Equivalent to Partial Nephrectomy for Preserving Renal Function in Patients with Small Renal Masses: Results from the DISSRM Registry. J Urol 194:903–909CrossRefGoogle Scholar
  38. 38.
    Desai MM, Aron M, Gill IS (2005) Laparoscopic partial nephrectomy versus laparoscopic cryoablation for the small renal tumor. Urology 66:23–28CrossRefGoogle Scholar
  39. 39.
    Emara AM, Kommu SS, Hindley RG, Barber NJ (2014) Robot-assisted partial nephrectomy vs laparoscopic cryoablation for the small renal mass: redefining the minimally invasive 'gold standard'Google Scholar
  40. 40.
    Evans R, Abusanade O, Thwaini A, Keane J, Loan W (2017) Microwave ablation versus radiofrequency ablation for small renal lesions; a comparison of efficacy and safety. Eur Urol, Supplements 16(3):e639–e640CrossRefGoogle Scholar
  41. 41.
    Foyil KV, Ames CD, Ferguson GG et al (2008) Longterm changes in creatinine clearance after laparoscopic renal surgery. J Am Coll Surg 206:511–515CrossRefGoogle Scholar
  42. 42.
    Guan W, Bai J, Liu J et al (2012) Microwave ablation versus partial nephrectomy for small renal tumors: intermediate-term results. J Surg Oncol 106:316–321CrossRefGoogle Scholar
  43. 43.
    Guillotreau J, Haber GP, Autorino R et al (2012) Robotic partial nephrectomy versus laparoscopic cryoablation for the small renal mass. Eur Urol 61:899–904CrossRefGoogle Scholar
  44. 44.
    Haber GP, Lee MC, Crouzet S, Kamoi K, Gill IS (2012) Tumour in solitary kidney: laparoscopic partial nephrectomy vs laparoscopic cryoablation. BJU Int 109:118–124CrossRefGoogle Scholar
  45. 45.
    Haramis G, Graversen JA, Mues AC et al (2012) Retrospective comparison of laparoscopic partial nephrectomy versus laparoscopic renal cryoablation for small (<3.5 cm) cortical renal masses. J Laparoendosc Adv Surg Tech A 22:152–157CrossRefGoogle Scholar
  46. 46.
    Hegarty NJ, Gill IS, Desai MM, Remer EM, O'Malley CM, Kaouk JH (2006) Probe-ablative nephron-sparing surgery: cryoablation versus radiofrequency ablation. Urology 68:7–13CrossRefGoogle Scholar
  47. 47.
    Hinshaw JL, Best S, Wells SA et al (2016) Comparison of percutaneous microwave ablation, cryoablation and surgery for treatment of sporadic RCC <=4cm. Journal of Vascular and Interventional Radiology 27 (6):e68.  https://doi.org/10.1016/j.jvir.2016.04.006
  48. 48.
    Ji C, Zhao X, Zhang S et al (2016) Laparoscopic Radiofrequency Ablation versus Partial Nephrectomy for cT1a Renal Tumors: Long-Term Outcome of 179 Patients. Urol Int 96:345–353CrossRefGoogle Scholar
  49. 49.
    Kim SH, Lee ES, Kim HH et al (2015) A propensity-matched comparison of perioperative complications and of chronic kidney disease between robot-assisted laparoscopic partial nephrectomy and radiofrequency ablative therapy. Asian J Surg 38:126–133CrossRefGoogle Scholar
  50. 50.
    Klatte T, Mauermann J, Heinz-Peer G et al (2011) Perioperative, oncologic, and functional outcomes of laparoscopic renal cryoablation and open partial nephrectomy: a matched pair analysis. J Endourol 25:991–997CrossRefGoogle Scholar
  51. 51.
    Liu N, Huang D, Cheng X et al (2017) Percutaneous radiofrequency ablation for renal cell carcinoma vs. partial nephrectomy: Comparison of long-term oncologic outcomes in both clear cell and non-clear cell of the most common subtype. Urol Oncol 35:530.e531–530.e536CrossRefGoogle Scholar
  52. 52.
    Lucas SM, Stern JM, Adibi M, Zeltser IS, Cadeddu JA, Raj GV (2008) Renal Function Outcomes in Patients Treated for Renal Masses Smaller Than 4 cm by Ablative and Extirpative Techniques. J Urol 179:75–80CrossRefGoogle Scholar
  53. 53.
    Lughezzani G, Cestari A, Buffi NM et al (2009) 24 Nephron sparing surgery for the treatment of small renal masses: comparison between open partial nephrectomy, laparoscopic partial nephrectomy and laparoscopic cryoablation. Eur Urol Supplements 8:126Google Scholar
  54. 54.
    Mason RJ, Atwell TD, Lohse C et al (2017) Renal functional outcomes in patients undergoing percutaneous cryoablation or partial nephrectomy for a solitary renal mass. BJU Int 120:544–549CrossRefGoogle Scholar
  55. 55.
    O'Malley RL, Berger AD, Kanofsky JA, Phillips CK, Stifelman M, Taneja SS (2007) A matched-cohort comparison of laparoscopic cryoablation and laparoscopic partial nephrectomy for treating renal masses. BJU Int 99:395–398CrossRefGoogle Scholar
  56. 56.
    Olweny EO, Park SK, Tan YK, Best SL, Trimmer C, Cadeddu JA (2012) 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 61:1156–1161CrossRefGoogle Scholar
  57. 57.
    Pantelidou M, Challacombe B, McGrath A et al (2016) Percutaneous Radiofrequency Ablation Versus Robotic-Assisted Partial Nephrectomy for the Treatment of Small Renal Cell Carcinoma. Cardiovasc Interv Radiol 39:1595–1603CrossRefGoogle Scholar
  58. 58.
    Panumatrassamee K, Kaouk JH, Autorino R et al (2013) Cryoablation versus minimally invasive partial nephrectomy for small renal masses in the solitary kidney: impact of approach on functional outcomes. J Urol 189:818–822CrossRefGoogle Scholar
  59. 59.
    Psutka S, McDougal WS, Dahl D et al (2013) 1199 Radiofrequency ablation achieves comparable local oncological control to partial nephrectomy for T1 renal cell carcinoma. J Urol 189:e491Google Scholar
  60. 60.
    Raman JD, Raj GV, Lucas SM et al (2010) Renal functional outcomes for tumours in a solitary kidney managed by ablative or extirpative techniques. BJU Int 105:496–500CrossRefGoogle Scholar
  61. 61.
    Stern JM, Svatek R, Park S et al (2007) Intermediate comparison of partial nephrectomy and radiofrequency ablation for clinical T1a renal tumours. BJU Int 100:287–290CrossRefGoogle Scholar
  62. 62.
    Sung HH, Park BK, Kim CK, Choi HY, Lee HM (2012) Comparison of percutaneous radiofrequency ablation and open partial nephrectomy for the treatment of size- and location-matched renal masses. Int J Hyperthermia 28:227–234CrossRefGoogle Scholar
  63. 63.
    Takaki H, Yamakado K, Soga N et al (2010) Midterm results of radiofrequency ablation versus nephrectomy for T1a renal cell carcinoma. Jpn J Radiol 28:460–468CrossRefGoogle Scholar
  64. 64.
    Tanagho YS, Bhayani SB, Kim EH, Figenshau RS (2013) Renal cryoablation versus robot-assisted partial nephrectomy: Washington University long-term experience. J Endourol 27:1477–1486CrossRefGoogle Scholar
  65. 65.
    Thompson RH, Atwell T, Schmit G et al (2015) Comparison of partial nephrectomy and percutaneous ablation for cT1 renal masses. Eur Urol 67:252-259Google Scholar
  66. 66.
    Turna B, Kaouk JH, Frota R et al (2009) Minimally invasive nephron sparing management for renal tumors in solitary kidneys. J Urol 182:2150-2157Google Scholar
  67. 67.
    Wan S, Park BK, Kim CK et al (2017) MP100-07 Comparison of oncologic results, functional outcomes and complications after partial nephrectomy versus percutaneous radiofrequency ablation in small sized (4cm or less) Bosniak iii or iv cystic renal lesions. J Urol 197:e1332Google Scholar
  68. 68.
    Weinberg AC, Woldu SL, Wen T, Deibert CM, Korets R, Badani KK (2015) Utilization and perioperative complications of laparoscopic cryoablation vs. robotic partial nephrectomy for localized renal tumors. Int Braz J Urol 41:473–485CrossRefGoogle Scholar
  69. 69.
    Youn CS, Park JM, Lee JY et al (2013) Comparison of laparoscopic radiofrequency ablation and open partial nephrectomy in patients with a small renal mass. Korean J Urol 54:603–608CrossRefGoogle Scholar
  70. 70.
    Zechlinski JJ, Dybul S, Hohenwalter E et al (2016) Safety and efficacy of percutaneous renal ablation: Comparison of cryoablation and microwave ablation. J Vasc Interv Radiol 27(6):e67.  https://doi.org/10.1016/j.jvir.2016.04.006
  71. 71.
    Sterrett SP, Nakada SY, Wingo MS, Williams SK, Leveillee RJ (2008) Renal thermal ablative therapy. Urol Clin North Am 35:397–414 viiiCrossRefGoogle Scholar
  72. 72.
    Lee SH, Son HS, Cho S et al (2015) Which Patients Should We Follow up beyond 5 Years after Definitive Therapy for Localized Renal Cell Carcinoma? Cancer Res Treat 47:489–494CrossRefGoogle Scholar
  73. 73.
    Tomaszewski JJ, Uzzo RG, Kutikov A et al (2014) Assessing the burden of complications following surgery for clinically localized kidney cancer by age and co-morbidity status. Urology 83:843–850CrossRefGoogle Scholar
  74. 74.
    Huang WC, Levey AS, Serio AM et al (2006) Chronic kidney disease after nephrectomy in patients with renal cortical tumours: a retrospective cohort study. Lancet Oncol 7:735–740CrossRefGoogle Scholar
  75. 75.
    Weight CJ, Larson BT, Fergany AF et al (2010) Nephrectomy induced chronic renal insufficiency is associated with increased risk of cardiovascular death and death from any cause in patients with localized cT1b renal masses. J Urol 183:1317–1323CrossRefGoogle Scholar
  76. 76.
    Floridi C, De Bernardi I, Fontana F et al (2014) Microwave ablation of renal tumors: state of the art and development trends. Radiol Med 119:533–540CrossRefGoogle Scholar
  77. 77.
    de Castro Abreu AL, Papalia R, Gill I et al (2015) MP59-12 Functional & Trifecta outcomes in solitary kidney: unclamped vs clamped partial nephrectomy. J Urol 193:e734CrossRefGoogle Scholar

Copyright information

© European Society of Radiology 2018

Authors and Affiliations

  1. 1.Department of Diagnostic and Interventional RadiologyUniversity Medical Center GoettingenGoettingenGermany
  2. 2.Division of Interventional Radiology, Department of Radiology and Biomedical ImagingYale School of MedicineNew HavenUSA
  3. 3.Department of UrologyUniversity Medical Center GoettingenGoettingenGermany
  4. 4.Faculty of Medicine and Institute of Medical Biometry and StatisticsMedical Center - University of FreiburgFreiburgGermany
  5. 5.German Centre for Cardiovascular ResearchPartnersite GoettingenGoettingenGermany

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