[Energy ablative therapy of renal tumours]

Solid renal tumours with a diameter <4 cm may be effectively cured by partial nephrectomy but this is associated with a complication rate of 15-20%. In addition, these tumours are more frequently diagnosed in the elderly (<70 years) and 26% are aggressive G3 and potentially hazardous tumours. Since these tumours are frequently unifocal, spherical, peripherally located and easily accessible for minimally invasive approaches, energy ablative techniques are attractive less invasive therapeutic options. These tumours may be treated by freezing (cryoablation) or by heat (radiofrequency ablation, high intensified focused ultrasound). Cryoablation seems to be the most reliable technique with a 1.6% recurrence rate over 3 years follow-up but only 1.8% complications. Conversely skipping renders RFA unreliable in highly vascularised tumours >3 cm with 23% vital tumours to be found at histological work-up. Laparoscopic HIFU is still experimental. Percutaneous techniques are less effective as compared with laparoscopy with recurrence rates ranging between 13-21% (cryoablation) and 14-18% (RFA). In addition, oncological follow-up relies solely on radiological measurements, frequently without histological verification thus making percutaneous techniques unpredictable.