Partial nephrectomy versus ablative techniques for small renal masses: a systematic review and network meta-analysis

Uhlig, Johannes; Strauß, Arne; Rücker, Gerta; Hosseini, Ali; Lotz, Joachim; Trojan, Lutz; Uhlig, Annemarie

doi:10.1007/s00330-018-5660-3

Cited by 91 publications

(65 citation statements)

References 70 publications

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“…The overall AE rate of 19% was relatively high compared to previous percutaneous ablation and surgical studies [9,32]. However, most AEs were low grade (15%) with minimal consequences for the patient.…”

Section: Discussionmentioning

confidence: 66%

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Percutaneous Microwave Ablation of Histologically Proven T1 Renal Cell Carcinoma

Aarts

Prevoo

Meier

et al. 2020

Cardiovasc Intervent Radiol

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Objectives To assess the safety and efficacy of percutaneous microwave ablation (MWA) of histologically proven T1 renal cell carcinoma (RCC). Methods We analysed patients with a histologically proven RCC (B 7 cm) treated by MWA from April 2012-April 2018. Primary and secondary efficacy, local tumour recurrence (LTR), morbidity and mortality were reported. Efficacy was defined as no residual tumour enhancement on follow-up imaging 1 month after the first ablation (primary efficacy) and after re-ablation(s) for residual disease (secondary efficacy). Adverse events (AE) were registered by the Clavien-Dindo classification and the common terminology criteria for AE. Univariable and multivariable logistic regression analyses were performed to investigate a relation among pre-treatment factors incomplete ablation and complications. Results In 100 patients, a total of 108 RCCs (85 T1a and 23 T1b) were treated by MWA. Median size was 3.2 cm (IQR 2.4-4.0). Primary efficacy was 89% (95%CI 0.81-0.94) for T1a lesions and 52% (95%CI 0.31-0.73) for T1b lesions (p \ 0.001). Fifteen lesions (7 T1a) were reablated for residual disease by MWA in one (n = 13) and two (n = 2, both T1b) sessions resulting in secondary efficacy rates of 99% (T1a) and 95% (T1b, p = 0.352). LTR occurred in four tumours (2 T1a, 2 T1b) after 10-60 months. Six (4%) AEs grade [ 3-5 were observed (2 T1a, 4 T1b, p = 0.045). Multivariable analysis showed that mR.E.N.A.L. nephrometry was independently associated with incomplete ablation (p = 0.012). Conclusion Microwave ablation is safe and effective for T1a and T1b RCC lesions with a significantly lower primary efficacy for T1b lesions.

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Section: Discussionmentioning

confidence: 66%

“…Percutaneous tumour ablation is reserved for co-morbid patients and patients not eligible for surgery [21,25]. Although reports show higher local control after PN compared to ablative therapies, similar cancer-specific survival is obtained with less renal function decline for radiofrequency ablation (RFA) and cryoablation (CA) [32].…”

Section: Introductionmentioning

confidence: 99%

Percutaneous Microwave Ablation of Histologically Proven T1 Renal Cell Carcinoma

Aarts

Prevoo

Meier

et al. 2020

Cardiovasc Intervent Radiol

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“…RFA was associated with the least severe decline in renal function following treatment. 35 Compared with PN, CRA and MWA had significantly lower complication rates. Most of the studies included in this analysis did not adjust for confounders, and when they were adjusted, no significant differences in mortality were identified.…”

Section: Review Of Contemporary Oncologic Outcomesmentioning

confidence: 92%

“…A systematic review and meta-analysis of 24,077 patients compared patients undergoing CRA, RFA, MWA, and PN with articles published from 2005-2017. 35 TA included both percutaneous and laparoscopic approaches. All-cause mortality was significantly higher for CRA and RFA patients compared with PN, but cancer-specific mortality was not significantly different.…”

Section: Review Of Contemporary Oncologic Outcomesmentioning

confidence: 99%

Systematic Review of Contemporary Evidence for the Management of T1 Renal Cell Carcinoma: What IRs Need to Know for Kidney Cancer Tumor Boards

Cronan

Dariushnia

Bercu

et al. 2019

Semin intervent Radiol

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Renal cell carcinoma is a relatively common malignancy, with 60 to 70 thousand cases a year in the United States alone. Increased utilization of cross-sectional imaging has led to an increase in the number of early renal cell cancers seen by the medical establishment. In addition, certain patient populations have an increased risk of developing kidney cancers which may mandate aggressive screening protocols. This article discusses the epidemiology of renal cell cancers; discusses the current management guidelines from multiple specialty societies; discusses some of the surgical and interventional techniques used in the treatment of such lesions; and provides a review of the literature regarding treatments of early-stage renal cell cancers.

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“…RFA is the preferred AT for KTx neoplasms (approximately, 80% of all the procedures reported in the literature)[ 14 , 48 ]. Excellent oncological and functional outcomes in the treatment of solid masses in native kidneys have undoubtedly favoured its application in the transplant setting[ 49 - 52 ]. RFA uses high-frequency alternating electrical current to force extra- and intra-cellular ions to follow the same route as the current thus generating agitation, frictional heat, and coagulative necrosis[ 53 ].…”

Section: Treatment Options and Treatment-specific Outcomesmentioning

confidence: 99%

Treatment options for localised renal cell carcinoma of the transplanted kidney

Motta¹,

Ferraresso²,

Lamperti³

et al. 2020

WJT

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Currently, there is no consensus among the transplant community about the treatment of renal cell carcinoma (RCC) of the transplanted kidney. Until recently, graftectomy was universally considered the golden standard, regardless of the characteristics of the neoplasm. Due to the encouraging results observed in native kidneys, conservative options such as nephron-sparing surgery (NSS) (enucleation and partial nephrectomy) and ablative therapy (radiofrequency ablation, cryoablation, microwave ablation, high-intensity focused ultrasound, and irreversible electroporation) have been progressively used in carefully selected recipients with early-stage allograft RCC. Available reports show excellent patient survival, optimal oncological outcome, and preserved renal function with acceptable complication rates. Nevertheless, the rarity and the heterogeneity of the disease, the number of options available, and the lack of long-term follow-up data do not allow to adequately define treatment-specific advantages and limitations. The role of active surveillance and immunosuppression management remain also debated. In order to offer a better insight into this difficult topic and to help clinicians choose the best therapy for their patients, we performed and extensive review of the literature. We focused on epidemiology, clinical presentation, diagnostic work up, staging strategies, tumour characteristics, treatment modalities, and follow-up protocols. Our research confirms that both NSS and focal ablation represent a valuable alternative to graftectomy for kidney transplant recipients with American Joint Committee on Cancer stage T1aN0M0 RCC. Data on T1bN0M0 lesions are scarce but suggest extra caution. Properly designed multi-centre prospective clinical trials are warranted.

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Partial nephrectomy versus ablative techniques for small renal masses: a systematic review and network meta-analysis

Cited by 91 publications

References 70 publications

Percutaneous Microwave Ablation of Histologically Proven T1 Renal Cell Carcinoma

Percutaneous Microwave Ablation of Histologically Proven T1 Renal Cell Carcinoma

Systematic Review of Contemporary Evidence for the Management of T1 Renal Cell Carcinoma: What IRs Need to Know for Kidney Cancer Tumor Boards

Treatment options for localised renal cell carcinoma of the transplanted kidney

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