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Updated: Jul 7, 2026
In Vivo, Percutaneous, Needle Based, Optical Coherence Tomography of Renal Masses
Published on: March 30, 2015
Excise, ablate or observe: the small renal mass dilemma--a meta-analysis and review
David A Kunkle1, Brian L Egleston, Robert G Uzzo
1Department of Urologic Oncology, Fox Chase Cancer Center, Temple University School of Medicine, Philadelphia, Pennsylvania 19111, USA.
Purpose:
The incidence of renal cell carcinoma is increasing due to the incidental detection of small renal masses. Resection, predominantly by nephron sparing surgery, remains the standard of care due to its durable oncological outcomes. Active surveillance and ablative technologies have emerged as alternatives to surgery in select patients. We performed a meta-analysis of published data evaluating nephron sparing surgery, cryoablation, radio frequency ablation and observation for small renal masses to define the current data.
Materials And Methods:
A MEDLINE search was performed for clinically localized sporadic renal masses. Patient age, tumor size, duration of followup, available pathological data and oncological outcomes were evaluated.
Results:
A total of 99 studies representing 6,471 lesions were analyzed. Significant differences in mean patient age (p <0.001), tumor size (p <0.001) and followup duration (p <0.001) were detected among treatment modalities. The incidence of unknown/indeterminate pathological findings was significantly different among cryoablation, radio frequency ablation and observation (p = 0.003), and a significant difference in the rates of malignancy among lesions with known pathological results was detected (p = 0.001). Compared to nephron sparing surgery significantly increased local progression rates were calculated for cryoablation (RR = 7.45) and radio frequency ablation (RR = 18.23). However, no statistical differences were detected in the incidence of metastatic progression regardless of whether lesions were excised, ablated or observed.
Conclusions:
Nephron sparing surgery, ablation and surveillance are viable strategies for small renal masses based on short-term and intermediate term oncological outcomes. However, a significant selection bias exists in the application of these techniques. While long-term data have demonstrated durable outcomes for nephron sparing surgery, extended oncological efficacy is lacking for ablation and surveillance strategies. The extent to which treatment alters the natural history of small renal masses is not yet established.
Insights
Nephron sparing surgery, ablation, and surveillance are viable for small renal masses. However, long-term data is lacking for ablation and surveillance, and selection bias is significant.
Area of Science:
- Urology
- Oncology
- Medical Technology
Background:
- Increasing incidence of renal cell carcinoma (RCC) due to incidental detection of small renal masses.
- Nephron sparing surgery (NSS) is the standard of care for small renal masses, offering durable oncological outcomes.
- Active surveillance and ablative technologies (cryoablation, radiofrequency ablation) are emerging alternatives for select patients.
Purpose of the Study:
- To perform a meta-analysis of published data on NSS, cryoablation, radiofrequency ablation, and observation for small renal masses.
- To define the current data and compare oncological outcomes of different treatment modalities.
- To evaluate patient age, tumor size, follow-up duration, pathological data, and oncological outcomes.
Main Methods:
- MEDLINE search for clinically localized sporadic renal masses.
- Inclusion of 99 studies representing 6,471 lesions.
- Evaluation of patient demographics, tumor characteristics, follow-up duration, and oncological outcomes.
Main Results:
- Significant differences in patient age, tumor size, and follow-up duration across treatment modalities.
- Significant differences in unknown/indeterminate pathological findings and malignancy rates among ablation and observation groups.
- Higher local progression rates for cryoablation (RR=7.45) and radiofrequency ablation (RR=18.23) compared to NSS, with no difference in metastatic progression rates.
Conclusions:
- NSS, ablation, and surveillance are viable for small renal masses based on short- to intermediate-term outcomes.
- Significant selection bias exists in the application of these treatments.
- Long-term oncological efficacy data for ablation and surveillance are lacking, and the impact on natural history is not established.
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