Partial nephrectomy versus ablative therapies for cT1a renal masses: A Systematic Review and meta-analysis

Society of Interventional Radiology Quality Improvement Standards on Percutaneous Ablation in Renal Cell Carcinoma

“…Local tumor progression after IGTA of T1a RCC occurs in 2% to 4.7% of patients with a weighted mean of 4.2% (15,17,19,68,75). The threshold for local tumor progression after IGTA for T1a RCC is 6%.…”

“…This recommendation stems primarily from early single-institution, retrospective series showing higher technical efficacy, improved oncologic outcomes, and reduced complications for tumors 3 cm (25-28). However, larger, more recent, population-based studies have found that IGTA results in cancer-specific survival equivalent to that of PN for patients with T1a disease (ie, including tumors up to 4 cm in size) with an overall lower rate of complications (19)(20)(21)(22)(23). Given these findings, it is appropriate to classify all T1a tumors as small renal masses potentially amenable to IGTA for curative intent.…”

“…IGTA is a particularly attractive option for patients considered unable to tolerate extirpative surgery or who wish to pursue a less invasive therapeutic option. IGTA can also be useful in patients in whom preserving renal function is paramount, such as those with preexisting chronic kidney disease or hereditary conditions resulting in multiple RCCs (19)(20)(21)(22)(23). For patients who are poor surgical candidates with larger but still localized RCC (eg, T1b or T2 disease), IGTA can still be considered as a potentially curative option as several case series have shown it to be both safe and efficacious in this setting (9-17); although, local tumor progression remains a concern (21).…”

“…Less frequently, complications include pneumothorax, tract seeding, skin injury, nerve injury, ileus, hypertension, episodes of arrhythmia, myocardial infarction, stroke, pulmonary embolism, pneumonia, pulmonary edema, and segmental renal infarction. Major complications after IGTA for T1a RCC have been reported in up to 6% of patients with an overall complication rate of up to 21% (19,20,(22)(23)(24)68,69,75). Reported rates of individual complications are shown in in Table 4.…”

“…Regardless of modality, IGTA can be a particularly effective therapeutic approach for patients who either cannot tolerate or do not wish to proceed with a conventional surgical approach or active surveillance. Furthermore, IGTA is associated with a greater preservation of renal function, lower rates of complications, and decreased costs compared with surgery (19)(20)(21)(22)(23). Given these advantages, interventional radiology plays an important role in the multidisciplinary care of patients with RCC.…”