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Percutaneous Ablation Versus Nephrectomy for Small Renal Masses: Clinical Outcomes in a Single-Center Cohort

  • Clinical Investigation
  • Non-Vascular Interventions
  • Published:
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Abstract

Purpose

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.

Results

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).

Conclusion

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.

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References

  1. Finelli A, Ismaila N, Bro B, Durack J, Eggener S, Evans A, et al. Management of small renal masses: American Society of Clinical Oncology clinical practice guideline. J Clin Oncol. 2017;35(6):668–80. https://doi.org/10.1200/JCO.2016.69.9645.

    Article  PubMed  Google Scholar 

  2. Rini BI, Campbell SC, Escudier B. Renal cell carcinoma. Lancet. 2009;373(9669):1119–32. https://doi.org/10.1016/S0140-6736(09)60229-4.

    Article  CAS  PubMed  Google Scholar 

  3. Chow WH, Devesa SS, Warren JL, Fraumeni JF Jr. Rising incidence of renal cell cancer in the United States. JAMA. 1999;281(17):1628–31.

    Article  CAS  Google Scholar 

  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.

    Article  PubMed  Google 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.

    Article  PubMed  Google 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.

    Article  PubMed  Google 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.

    Article  PubMed  Google Scholar 

  8. Yin X, Cui L, Li F, Qi S, Yin Z, Gao J. Radiofrequency ablation versus partial nephrectomy in treating small renal tumors: a systematic review and meta-analysis. Medicine. 2015;94(50):e2255. https://doi.org/10.1097/MD.0000000000002255.

    Article  PubMed  PubMed Central  Google Scholar 

  9. Wang S, Qin C, Peng Z, Cao Q, Li P, Shao P, et al. Radiofrequency ablation versus partial nephrectomy for the treatment of clinical stage 1 renal masses: a systematic review and meta-analysis. Chin Med J. 2014;127(13):2497–503.

    PubMed  Google Scholar 

  10. Takaki H, Soga N, Kanda H, Nakatsuka A, Uraki J, Fujimori M, et al. Radiofrequency ablation versus radical nephrectomy: clinical outcomes for stage T1b renal cell carcinoma. Radiology. 2014;270(1):292–9. https://doi.org/10.1148/radiol.13130221.

    Article  PubMed  Google 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.

    Article  PubMed  Google Scholar 

  12. Ortiz-Alvarado O, Anderson JK. The role of radiologic imaging and biopsy in renal tumor ablation. World J Urol. 2010;28(5):551–7. https://doi.org/10.1007/s00345-010-0549-z.

    Article  PubMed  Google 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.

    Article  PubMed  PubMed Central  Google Scholar 

  14. Sankar A, Johnson SR, Beattie WS, Tait G, Wijeysundera DN. Reliability of the American Society of Anesthesiologists physical status scale in clinical practice. Br J Anaesth. 2014;113(3):424–32. https://doi.org/10.1093/bja/aeu100.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  15. Yoon PD, Chalasani V, Woo HH. Use of Clavien–Dindo classification in reporting and grading complications after urological surgical procedures: analysis of 2010 to 2012. J Urol. 2013;190(4):1271–4. https://doi.org/10.1016/j.juro.2013.04.025.

    Article  PubMed  Google Scholar 

  16. Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg. 2004;240(2):205–13.

    Article  Google Scholar 

  17. Zagoria RJ. Imaging of small renal masses: a medical success story. AJR Am J Roentgenol. 2000;175(4):945–55. https://doi.org/10.2214/ajr.175.4.1750945.

    Article  CAS  PubMed  Google 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.

    Article  PubMed  Google Scholar 

  19. Richard PO, Jewett MA, Bhatt JR, Kachura JR, Evans AJ, Zlotta AR, et al. Renal tumor biopsy for small renal masses: a single-center 13-year experience. Eur Urol. 2015;68(6):1007–13. https://doi.org/10.1016/j.eururo.2015.04.004.

    Article  PubMed  Google Scholar 

  20. Memarsadeghi M, Schmook T, Remzi M, Weber M, Potscher G, Lammer J, et al. Percutaneous radiofrequency ablation of renal tumors: midterm results in 16 patients. Eur J Radiol. 2006;59(2):183–9. https://doi.org/10.1016/j.ejrad.2006.04.012.

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Radiology, University of British Columbia, Vancouver, BC, Canada

    Pedro Lourenco, Nicolas Bilbey, Bo Gong, Arvin Bahrabadi & Bradley Halkier

  2. Department of Radiology, McGill University, Montreal, QC, Canada

    Pedro Lourenco

  3. Royal Columbian Hospital, New Westminster, BC, Canada

    Bradley Halkier

Authors
  1. Pedro Lourenco
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  2. Nicolas Bilbey
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  3. Bo Gong
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  4. Arvin Bahrabadi
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Corresponding author

Correspondence to Pedro Lourenco.

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The authors declare that they have no conflict of interest.

Informed Consent

This study has obtained IRB approval from the Fraser Health Research Ethics Board and the need for informed consent was waived.

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Lourenco, P., Bilbey, N., Gong, B. et al. Percutaneous Ablation Versus Nephrectomy for Small Renal Masses: Clinical Outcomes in a Single-Center Cohort. Cardiovasc Intervent Radiol 41, 1892–1900 (2018). https://doi.org/10.1007/s00270-018-2050-9

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  • DOI: https://doi.org/10.1007/s00270-018-2050-9

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