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Updated: Feb 16, 2026
Rapid Depletion of Renal Macrophages Using Human CD59/Intermedilysin Cell Ablation Tool
Published on: May 9, 2025
Surveillance versus ablation for incidentally diagnosed small renal tumours: the SURAB feasibility RCT
Naeem Soomro1, Jan Lecouturier2, Deborah D Stocken2,3
1The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK.
Background:
There is uncertainty around the appropriate management of small renal tumours. Treatments include partial nephrectomy, ablation and active surveillance.
Objectives:
To explore the feasibility of a randomised trial of ablation versus active surveillance.
Design:
Two-stage feasibility study: stage 1 - clinician survey and co-design work; and stage 2 - randomised feasibility study with qualitative and economic components.
Methods:
Stage 1 - survey of radiologists and urologists, and development of patient information materials. Stage 2 - patients identified across eight UK centres with small renal tumours (< 4 cm) were randomised (1 : 1 ratio) to ablation or active surveillance in an unblinded manner. Randomisation was carried out by a central computer system. The primary objective was to determine willingness to participate and to randomise a target of 60 patients. The qualitative and economic data were collected separately.
Results:
The trial was conducted across eight centres, with a site-specific period of recruitment ranging from 3 to 11 months. Of the 154 patients screened, 36 were eligible and were provided with study details. Seven agreed to be randomised and one patient was found ineligible following biopsy results. Six patients (17% of those eligible) were randomised: three patients received ablation and no serious adverse events were recorded. The 3- and 6-month data were collected for four (67%) and three (50%) out of the six patients, respectively. The qualitative substudy identified factors directly impacting on the recruitment of this trial. These included patient and clinician preferences, organisational factors (variation in clinical pathway) and standard treatment not included. The health economic questionnaire was designed and piloted; however, the sample size of recruited patients was insufficient to draw a conclusion on the feasibility of the health economics.
Conclusions:
The trial did not meet the criteria for progression and the recruitment rate was lower than hypothesised, demonstrating that a full trial is presently not possible. The qualitative study identified factors that led to variation in recruitment across the sites. Implementation of organisational and operational measures can increase recruitment in any future trial. There was insufficient information to conduct a full economic analysis.
Trial Registration:
Current Controlled Trials ISRCTN31161700.
Funding:
This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 21, No. 81. See the NIHR Journals Library website for further project information.
Insights
A feasibility study for a randomized trial comparing ablation and active surveillance for small renal tumors found recruitment challenges. Future trials require organizational improvements to increase patient participation.
Area of Science:
- Urology
- Oncology
- Clinical Trials
Background:
- Management of small renal tumors lacks definitive guidance.
- Current treatment options include partial nephrectomy, ablation, and active surveillance.
Purpose of the Study:
- To assess the feasibility of a randomized trial comparing ablation versus active surveillance for small renal tumors.
- To explore patient and clinician willingness to participate in such a trial.
Main Methods:
- A two-stage feasibility study was conducted.
- Stage 1 involved clinician surveys and co-design. Stage 2 was a randomized feasibility study with qualitative and economic components.
- Patients with small renal tumors (<4 cm) were recruited across eight UK centers.
Main Results:
- Only six patients were randomized (17% of eligible), falling short of the target of 60.
- Qualitative data revealed patient/clinician preferences and organizational factors impacted recruitment.
- The sample size was insufficient for economic analysis.
Conclusions:
- The randomized trial did not meet progression criteria due to low recruitment.
- Organizational and operational strategies are needed to improve recruitment for future studies.
- Further research is required to establish the feasibility of health economic analysis.
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