Active surveillance and focal ablation for small renal masses: a better solution for comorbid patients

Abstract

The natural history of small renal masses (SRM) is still not well understood and they are frequently incidentally diagnosed in elderly patients. Therefore, there is a need for less invasive options sparing the patient from the side-effects related to conventional surgical treatment. PubMed and Medline database search was performed to look for new findings on active surveillance and focal therapy for SRM. Sixty-one articles published between 2002 and 2018 were selected for the purpose of the review. There is growing evidence confirming the safety of active surveillance in patients at surgical risk and there appears to be a satisfactory intermediate-term outcome of focal treatment of SRM. In the group of elderly patients with a decreased life expectancy active surveillance appears to be the most appropriate approach. The future of minimally invasive therapy appears bright, especially with the improvement of new imaging modalities.

The Role of Focal Therapy and Active Surveillance for Small Renal Mass Therapy

“…In this article, we have updated the publication of Wośkowiak et al [ 48 ], the data of TA procedures presented in our paper present results similar or better than the articles published before 2018. These conclusions were made on the basis of summary tables ( Table 1 and Table 2 ), as well as analyzed guidelines and other reports from recent years.…”

“…In our review paper, we collected results from 24 papers on SRM ablative techniques. In total, the data cover 2150 patients at stage cT1a or cT1b, and includes more advanced tumors than previous reports [ 48 ].…”

“…Wośkowiak et al [ 48 ] pointed out that data on long term follow-up of CA and RFA are limited. We managed to find results [ 16 , 34 ] on 10 year survival with mean OS, RFS, DSS, MFS of 72.95%, 80.65%, 97%, 100%, respectively for CA and 5 year [ 26 , 27 , 34 ] for RFA with mean OS, RFS, DSS, MFS of 87.8%, 95.8%, 98.13% and 97.07%, respectively, which are superior to the OS, RFS, DSS and MFS results of 75.8%, 93.5%, 97.9% and 87.7% in a study [ 50 ] mentioned in an earlier review [ 48 ].…”

Ultrasound-Guided Percutaneous Thermal Ablation of Renal Cancers—In Search for the Ideal Tumour

“…While surgery is still the standard of care, there is a growing interest in Cancers 2023, 15, 518 2 of 10 minimally invasive treatment, such as thermal ablation [3]. The efficacy of thermal ablation has already been demonstrated, especially in case of SRMs, it is preferred for patients with renal masses ≤3 cm with contraindications or unwillingness to undergo surgery, especially people who are elderly, or have comorbidity, with bilateral tumours, and solitary kidney [4][5][6][7]. In addition to the good preservation of renal function, the percutaneous thermal ablation is also attractive because of much shorter hospital stay, lower cost, lower blood loss, shorter operative time, and acceptable morbidity in comparison to nephron sparing surgery (NSS) [2,4,8,9].…”

“…The efficacy of thermal ablation has already been demonstrated, especially in case of SRMs, it is preferred for patients with renal masses ≤3 cm with contraindications or unwillingness to undergo surgery, especially people who are elderly, or have comorbidity, with bilateral tumours, and solitary kidney [4][5][6][7]. In addition to the good preservation of renal function, the percutaneous thermal ablation is also attractive because of much shorter hospital stay, lower cost, lower blood loss, shorter operative time, and acceptable morbidity in comparison to nephron sparing surgery (NSS) [2,4,8,9]. US-guided percutaneous ablation is particularly attractive because it is a relatively simple procedure and it can be performed by urologists skilled in US-guided techniques [2,10].…”