Comparison of Percutaneous and Surgical Approaches to Renal Tumor Ablation: Metaanalysis of Effectiveness and Complication Rates

Hui, Gladwin; Tuncalı, Kemal; Tatlı, Servet; Morrison, Paul R.; Silverman, Stuart G.

doi:10.1016/j.jvir.2008.05.014

Cited by 187 publications

(101 citation statements)

References 61 publications

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“…Two major complications were observed. This is in line with previously described complication rates of 4 -6 % [22,23] and comparable to those observed in open partial nephrectomy (4.5 -8.7 %) [24]. In one case thermal damage led to bowel perforation with the need of immediate surgery and prolonged ICU treatment.…”

supporting

confidence: 91%

Percutaneous CT-Guided Radiofrequency Ablation of Solitary Small Renal Masses: A Single Center Experience

Pieper

Fischer

Strunk

et al. 2015

Fortschr Röntgenstr

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Purpose: To analyze the outcome of patients undergoing percutaneous CT-guided radiofrequency ablation (RFA) of small renal masses (SRM) at a single center during a ten-year time period. Materials and Methods: Patient records of renal RFAs (07/2003???11/2013) were reviewed. Indications were SRM suspicious of malignancy on imaging and one of the following: severe comorbidity; old age; solitary kidney; impaired renal function; patient wish. Biopsy was performed at the time of RFA. Patients were excluded if no follow-up was available. Patient and procedural characteristics were recorded. Survival rates were calculated using the Kaplan-Meier?s method and compared with log-rank or cox tests. Results: 38 patients (16 females, mean age 70.0 years [range 52???87]) presenting with a solitary SRM were included in the study. Biopsy showed malignancy in 29 patients; 9 had benign tumors. 26 patients suffered from cardiovascular, respiratory or hepatic comorbidities. Technical success (complete ablation on first follow-up) was achieved in 95?% of cases. Two major complications (bowel perforation; hematothorax) occurred. The 3- and 7-year overall survival (OS) [any cause] rates were 73.4???0.8?% and 50.3???1.0?%, respectively (mean follow-up 54.6 months, range 1???127). 4 recurrences and 2 metastases were observed. The presence of comorbidities was the only independent predictor of OS.?There was no difference in survival between patients with benign and malignant tumors. Conclusion: RFA of SRM is successful in a large percentage of cases with a low complication rate and durable local control. As RFA is typically performed in multimorbid patients, overall survival seems to depend primarily on comorbidities rather than cancer progression. Key Points ??RFA of SRM is technically successful in the majority of cases. ??RFA leads to a high degree of local tumor control. ??Post-RFA most patients ultimately die of comorbidities. ??Overall survival post-RFA does not significantly differ between benign and malignant tumors in multimorbid patients. Citation Format: ??Pieper C. C., Fischer S., Strunk H. et?al. Percutaneous CT-Guided Radiofrequency Ablation of Solitary Small Renal Masses: A Single Center Experience. Fortschr R?ntgenstr 2015; 187: 577???583

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supporting

confidence: 91%

Percutaneous CT-Guided Radiofrequency Ablation of Solitary Small Renal Masses: A Single Center Experience

Pieper

Fischer

Strunk

et al. 2015

Fortschr Röntgenstr

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“…In co-authoring this systematic review, EAU Renal Cancer Guideline Panel members and the UCAN Systematic Review Team have used the most rigorous research methods to assess the best evidence available for the management of localised renal cell carcinoma. A comparison between this systematic review with two other reviews [58,59] can be accessed in the full report [13]. Other reviews were either not systematically performed [60] or were based on noncomparative case series [61,62]; these will not be considered any further.…”

Section: How This Systematic Review Compares With Other Recent Systemmentioning

confidence: 99%

Systematic Review of Oncological Outcomes Following Surgical Management of Localised Renal Cancer

MacLennan

Imamura

Lapitan³

et al. 2012

European Urology

304

174

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Context: Renal cell carcinoma (RCC) accounts for 2-3% of adult malignancies. There remain uncertainties over the oncological outcomes for the surgical management of localised RCC. Objective: To systematically review relevant literature comparing oncological outcomes of surgical management of localised RCC (T1-2N0M0). Evidence Acquisition: Relevant databases including MEDLINE, Embase and the Cochrane Library were searched up to October 2010, and an updated scoping search was performed up to January 2012. Randomised or quasi-randomised controlled trials (RCTs), prospective observational studies with controls, retrospective matched-pair studies, and comparative studies from well defined registries/databases were included. The main outcomes were overall survival, cancer-specific survival, recurrence and metastases. The Cochrane risk of bias (RoB) tool was used to assess RCTs and an extended version was used to assess Non Randomised Studies (NRS). The quality of evidence was assessed using GRADE. Evidence Synthesis: 4580 abstracts and 389 full text articles were assessed. 34 studies met the inclusion criteria (6 RCTs and 28 NRSs). Meta-analyses were planned but were deemed inappropriate due to data heterogeneity. There were high risks of bias and low quality evidence across the evidence base. Open radical nephrectomy and open partial nephrectomy showed similar cancer-specific and overall survival, but when both open and laparoscopic approaches are considered together the evidence showed improved survival for partial nephrectomy for tumours ≤4cm.Overall, the evidence suggests either equivalent or better survival with partial nephrectomy. Laparoscopic radical nephrectomy offered equivalent survival to open radical nephrectomy, and all laparoscopic approaches achieved equivalent survival. Open and laparoscopic partial nephrectomy achieved equivalent survival. The issue of ipsilateral adrenalectomy or complete lymph node dissection with radical nephrectomy or partial nephrectomy remains unresolved. Conclusions: The evidence base suggests localised RCC are best managed by nephron sparing surgery where technically feasible. However, the current evidence base has significant limitations due to studies of low methodological quality marked by high risks of bias.

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“…Percutaneous RF ablation can be performed under conscious sedation or general anesthesia (Anderson, 2005;Carraway et 2009). Meta-analysis has shown that a percutaneous RF ablation procedure is safer and as equally effective as compared with an open or laparoscopic approach, although more than one treatment session may be needed to treat renal tumors completely (Hui et al, 2008).…”

Section: Guidance and Approachesmentioning

confidence: 99%

“…Recurrence is defined as new enhancement that develops after CT or MR images have been interpreted to show complete necrosis (Gervais et al, 2005b;Zagoria, 2004a). Effectiveness is defined by the proportion of tumors without residual enhancement after one treatment session (i.e., primary effectiveness) or after repeated treatments (i.e., secondary effectiveness) (Hui et al, 2008). In our series, 17 RCCs in 16 patients were subjected to RF ablation treatment.…”

Section: Outcomes 451 Therapeutic Efficacymentioning

confidence: 99%

Radiofrequency Ablation of Renal Cell Carcinoma: A Systematic Review

Yoon¹

2011

Advanced Laparoscopy

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Comparison of Percutaneous and Surgical Approaches to Renal Tumor Ablation: Metaanalysis of Effectiveness and Complication Rates

Cited by 187 publications

References 61 publications

Percutaneous CT-Guided Radiofrequency Ablation of Solitary Small Renal Masses: A Single Center Experience

Percutaneous CT-Guided Radiofrequency Ablation of Solitary Small Renal Masses: A Single Center Experience

Systematic Review of Oncological Outcomes Following Surgical Management of Localised Renal Cancer

Radiofrequency Ablation of Renal Cell Carcinoma: A Systematic Review

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