Comparison of Renal Parenchymal Volume Preservation Between Partial Nephrectomy, Cryoablation, and Radiofrequency Ablation Using 3D Volume Measurements

Woldu, Solomon L.; Thoreson, Gregory R.; Okhunov, Zhamshid; Ghandour, Rashed; Rothberg, Michael B.; RoyChoudhury, Arindam; Kim, Helen H. R.; Bozoghlanian, Mari; Newhouse, Jeffrey H.; Helmy, Mohammad; Badani, Ketan K.; Landman, Jamie; Cadeddu, Jeffrey A.; McKiernan, James M.

doi:10.1089/end.2014.0866

Cited by 44 publications

(35 citation statements)

References 22 publications

(24 reference statements)

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“…Woldu et al [36] in their recently published retrospective analysis concluded that ablative therapy modalities including cryoablation and RFA were associated with less Renal Parenchymal Volume (RPV) loss compared to partial nephrectomy with its three modalities (open, laparoscopic and robot assisted). Also in patients with chronic kidney disease who had cryoablation, their renal function was maintained [37,38].…”

Section: Preservation Of Renal Function After Ablative Treatmentmentioning

confidence: 99%

Ablative Therapy in 2016 for Small Renal Masses

Ian¹,

Farrag²,

Sriprasad³

2017

UNOAJ

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Introduction: Incidental diagnosis of small renal masses (SRMs), less than 4 cm in size, is increasing due to the widespread use of different forms of diagnostic imaging. The natural history of these tumours remains unknown and there is no reliable way to predict their behaviour or growth. Partial nephrectomy is currently the gold standard in the treatment of these tumours. However, the more minimally invasive, non-excisional, ablative therapies such as cryoablation (CRA) and radiofrequency ablation (RFA) are providing comparable oncological outcomes.Methods: This article critically reviews the principles, indications, modalities of treatment, oncological outcome, complication and effect on renal function, of the different ablative therapies.Results: Cryotherapy induces tissue ablation by freezing and thawing using argon and helium gases respectively.RFA ablates the tissue by heating. These Ablative treatments for SRMs are particularly indicated in the elderly patients, those with co-morbidities, in patients with solitary kidneys and in those with impaired renal function. The procedure related complication rate with ablative therapies are lower. These procedures have a promising medium term oncological outcome, while longer-term results are awaited. It appears that Cryotherapy may be evolving as a better modality for oncological control than RFA. Conclusion:The Ablative therapies for SRMs are emerging as viable treatment options with recurrence free survival rates approaching that of extirpative surgery. However, there is currently no consensus in the literature on the best selection criteria for this form of treatment. With further refinement of selection criteria and more prospective long-term data on the oncological outcome, these ablative methods would have a promising future in the management of SRMs.

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Section: Preservation Of Renal Function After Ablative Treatmentmentioning

confidence: 99%

Ablative Therapy in 2016 for Small Renal Masses

Ian¹,

Farrag²,

Sriprasad³

2017

UNOAJ

View full text Add to dashboard Cite

show abstract

“…A retrospective review of patients with SRMs treated by partial nephrectomy, cryoablation, or radiofrequency ablation revealed a comparatively decreased renal parenchymal volume loss with thermal ablation versus extirpation [9]. A corresponding and significant decrease in mean glomerular filtration rate (GFR) was also noted (−8.2 versus −13.7 %, respectively) [9]. Ji et al further found improved GFR for laparoscopic CA compared to partial nephrectomy with 5-year follow-up [44].…”

Section: Renal Function Outcomesmentioning

confidence: 99%

“…Conscious sedation can often be used, decreasing the risk of general anesthesia and hospitalization time [7]. Additionally, ablative techniques can limit normal parenchymal damage and therefore play a vital role in the management of patients at risk for end-stage renal disease, including those with solitary kidneys, bilateral renal tumors, and hereditary syndromes predisposing to multiple renal masses [8,9]. As ablative technologies develop and evolve, their role in RCC management will continue to broaden [10].…”

Section: Applications and Considerationsmentioning

confidence: 99%

“…Ablative techniques minimize normal renal parenchyma loss and improve long-term renal function compared to mass excision. A retrospective review of patients with SRMs treated by partial nephrectomy, cryoablation, or radiofrequency ablation revealed a comparatively decreased renal parenchymal volume loss with thermal ablation versus extirpation [9]. A corresponding and significant decrease in mean glomerular filtration rate (GFR) was also noted (−8.2 versus −13.7 %, respectively) [9].…”

Section: Renal Function Outcomesmentioning

confidence: 99%

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Ablative Therapies for the Treatment of Small Renal Masses: a Review of Different Modalities and Outcomes

2016

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The widespread utilization of abdominal imaging has led to an increase in incidentally detected small renal masses. Although partial nephrectomy is still considered the gold standard treatment for these masses, there are risks associated with surgical excision, potentially limiting treatment for older patients with multiple comorbidities. A variety of ablative techniques have developed over the past several decades, altering the management of small renal masses. It is likely that improvements in technology will only broaden the applications of ablative therapy. This article provides an update on the various ablative techniques and outcomes.

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“…There appears to be no detrimental loss of renal function even in patients with a single kidney. A recently published retrospective analysis by Woldu and colleagues concluded that ablative therapy modalities including cryoablation and RFA were associated with less renal parenchymal volume (RPV) loss compared to partial nephrectomy with its three modalities (open, laparoscopic and robot-assisted) [30]. It was also shown that renal function was maintained in patients with chronic kidney disease after they had cryoablation [31,32].…”

Section: Renal Function Preservationmentioning

confidence: 99%

Non-Surgical Ablative Therapy for Management of Small Renal Masses—Current Status and Future Trends

Farrag

Sriprasad

2016

Indian J Surg Oncol

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A large number of small renal masses (SRMs) with size less than 4 cm are being identified due to advances in diagnostic imaging. As the natural history of these tumours remains unknown, there is no reliable way to predict their behaviour or future growth. Although, partial nephrectomy is the gold standard for treatment of these tumours, ablative non-surgical therapies such as cryoablation and radiofrequency ablation provide a less invasive option of treatment with comparable oncological outcomes. In this systematic review, the principle, indications, methods of treatment, oncological control, complication and renal function of ablative therapies are critically reviewed. Cryotherapy utilizes the principle of inducing tissue destruction by freezing and thawing using argon and helium gasses, respectively. Radiofrequency ablation (RFA) works on the principle of tissue heating. Ablative treatments are particularly useful in the elderly patients, those with comorbidities or in patients with SRMs in solitary kidneys or renal impairment. Ablative therapies have less procedurerelated complications and have promising medium-term oncological outcome. Longer-term results are accumulating. Cryotherapy may be a better modality for oncological control than RFA. Ablative therapy has emerged as a viable treatment options for SRMs with recurrence free survival rates approaching that of extirpative surgery. However, there is no consensus in the literature on the best selection criteria and this needs further refinement. Prospective long-term data with regards to oncological control is still needed

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Comparison of Renal Parenchymal Volume Preservation Between Partial Nephrectomy, Cryoablation, and Radiofrequency Ablation Using 3D Volume Measurements

Abstract: TA is associated with less RPV loss than PN in the management of SRM, but there is no difference between modalities of TA (CA vs RFA) or between approaches to PN.

Cited by 44 publications

References 22 publications

Ablative Therapy in 2016 for Small Renal Masses

Ablative Therapy in 2016 for Small Renal Masses

Ablative Therapies for the Treatment of Small Renal Masses: a Review of Different Modalities and Outcomes

Non-Surgical Ablative Therapy for Management of Small Renal Masses—Current Status and Future Trends

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