[Ablative therapy of small renal masses]

Area of Science:

• Urology
• Oncology
• Minimally Invasive Surgery

Background:

• Renal cell carcinoma is often diagnosed early due to advanced imaging.
• Small renal masses (<4 cm) typically have indolent biology, with up to 30% being benign.
• There's a growing need for less invasive treatments than nephron-sparing surgery.

Purpose of the Study:

• To review local ablation techniques for small renal tumors.
• To assess the efficacy and safety of tumor ablation compared to surgery.
• To identify patient populations who may benefit most from ablation.

Main Methods:

• Review of radiofrequency ablation, cryoablation, microwave ablation, and irreversible electroporation.
• Comparison of percutaneous and laparoscopic approaches.
• Analysis of oncological outcomes and complication rates from comparative studies and meta-analyses.

Main Results:

• Tumor ablation, particularly percutaneous, is less invasive than surgery with lower complication risks.
• While local recurrence rates may be higher after ablation, long-term oncological results are comparable to partial nephrectomy.
• Tumor biopsy prior to ablation is safe and aids in differentiating benign from malignant lesions.

Conclusions:

• Tumor ablation is a viable, less invasive therapeutic option for small renal masses.
• It offers promising long-term oncological control, especially for elderly patients or those with hereditary renal cell carcinoma.
• Pre-intervention tumor biopsy is crucial for accurate diagnosis and preventing overtreatment.