A Systematic Review and Meta-Analysis of Minimally Invasive Partial Nephrectomy Versus Focal Therapy for Small Renal Masses

Abstract

BackgroundMinimally invasive partial nephrectomy (MIPN) and focal therapy (FT) are popular trends for small renal masses (SRMs). However, there is currently no systematic comparison between MIPN and FT of SRMs. Therefore, we systematically study the perioperative, renal functional, and oncologic outcomes of MIPN and FT in SRMs.MethodsWe have searched the Embase, Cochrane Library, and PubMed for articles between MIPN (robot-assisted partial nephrectomy and laparoscopic partial nephrectomy) and FT {radiofrequency ablation (RFA), microwave ablation (MWA), cryoablation (CA), irreversible electroporation, non-thermal [irreversible electroporation (IRE)] ablation, and stereotactic body radiation therapy (SBRT)}. We calculated pooled mean difference (MD), odds ratios (ORs), and 95% confidence intervals (CIs) (CRD42021260787).ResultsA total of 26 articles (n = 4,420) were included in the study. Compared with MIPN, the operating time (OP) of FT had significantly lower (SMD, −1.20; CI, −1.77 to −0.63; I2 = 97.6%, P < 0.0001), estimated blood loss (EBL) of FT had significantly less (SMD, −1.20; CI, −1.77 to −0.63; I2 = 97.6%, P < 0.0001), length of stay (LOS) had shorter (SMD, −0.90; CI, −1.26 to −0.53; I2 = 92.2%, P < 0.0001), and estimated glomerular filtration rate (eGFR) of FT was significantly lower decrease (SMD, −0.90; CI, −1.26 to −0.53; I2 = 92.2%, P < 0.0001). However, FT possessed lower risk in minor complications (Clavien 1–2) (OR, 0.69; CI, 0.45 to 1.07; I2 = 47%, P = 0.023) and overall complications (OR, 0.71; CI, 0.51 to 0.99; I2 = 49.2%, P = 0.008). Finally, there are no obvious difference between FT and MIPN in local recurrence, distant metastasis, and major complications (P > 0.05).ConclusionFT has more advantages in protecting kidney function, reducing bleeding, shortening operating time, and shortening the length of stay. There is no difference in local recurrence, distant metastasis, and major complications. For the minimally invasive era, we need to weigh the advantages and disadvantages of all aspects to make comprehensive choices.Systematic Review Registrationhttps://www.crd.york.ac.uk/PROSPERO/#recordDetails, identifier PROSPERO (CRD42021260787).

Cryoablation for the Treatment of Kidney Cancer: Comparison With Other Treatment Modalities and Review of Current Treatment

“…When compared to partial nephrectomy in a three-year actuarial analysis, it’s shown that RFA for cT1a kidney tumors has similar oncological outcomes [ 30 ]. Recent studies have shown renal ablation compared to partial nephrectomy leads to preserved renal function, decreased bleeding risk/time, decreased length of operation, and decreased length of stay [ 11 ]. Another study comparing RFA and partial nephrectomy determined that oncological and functional outcomes were similar and that both are safe and effective procedures for small tumors in a solitary kidney [ 28 ].…”

“…Focal therapy with cryoablation can preserve renal function, decrease bleeding risk/time, and decrease the length of stay, all desirable outcomes contributing to the procedure’s rising popularity. The procedure is also associated with shorter operating times [ 11 ]. Despite evidence supporting cryotherapy, current guidelines, notably those from the American Urological Association (AUA) and the European Association of Urology (EAU), recommend partial nephrectomy for renal masses <4 cm and advanced metastatic disease often requires medical management or radiation therapy (RT) to slow progression [ 12 , 13 ].…”

Efficacy and safety of cryoablation for localized renal tumor as an alternative approach to partial nephrectomy

“…Among them, loss of renal function can be important following radical nephrectomy, but not neglectable after partial nephrectomy (PN) ( 3 – 5 ). Minimally invasive approaches have been developed in interventional radiology, including percutaneous radiofrequency ablation (RFA), cryoablation (CA), or microwave ablation (MWA), which presented some benefits in limiting blood loss and post-procedure pain, shortening operating time and stay length, and better preserving renal function compared to surgical approach ( 6 ). Since percutaneous ablation showed comparable oncological outcomes to surgery for small RCC ( 7 – 9 ), both the American Urological Association (AUA) and the European Association of Urology (EAU) have validated RFA and CA as possible treatments for RCC inferior to 4 cm (T1a) ( 10 , 11 ).…”