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Published on: April 29, 2014
Partial nephrectomy versus ablative techniques for small renal masses: a systematic review and network meta-analysis
Johannes Uhlig1,2, Arne Strauss3, Gerta Rücker4
1Department of Diagnostic and Interventional Radiology, University Medical Center Goettingen, Goettingen, Germany.
Purpose:
To compare partial nephrectomy (PN), radiofrequency ablation (RFA), cryoablation (CRA) and microwave ablation (MWA) regarding oncologic, perioperative and functional outcomes.
Material And Methods:
The MEDLINE, EMBASE and COCHRANE libraries were searched for studies comparing PN, RFA, CRA or MWA and reporting on any-cause or cancer-specific mortality, local recurrence, complications or renal function. Network meta-analyses were performed.
Results:
Forty-seven studies with 24,077 patients were included. Patients receiving RFA, CRA or MWA were older and had more comorbidities compared with PN. All-cause mortality was higher for CRA and RFA compared with PN (incidence rate ratio IRR = 2.58, IRR = 2.58, p < 0.001, respectively). No significant differences in cancer-specific mortality were evident. Local recurrence was higher for CRA, RFA and MWA compared with PN (IRR = 4.13, IRR = 1.79, IRR = 2.52, p < 0.05 respectively). A decline in renal function was less pronounced after RFA versus PN, CRA and MWA (mean difference in GFR MD = 6.49; MD = 5.82; MD = 10.89, p < 0.05 respectively).
Conclusion:
Higher overall survival and local control of PN compared with ablative therapies did not translate into significantly better cancer-specific mortality. Most studies carried a high risk of bias by selecting younger and healthier patients for PN, which may drive superior survival and local control. Physicians should be aware of the lack of high-quality evidence and the potential benefits of ablative techniques for certain patients, including a superior complication profile and renal function preservation.
Key Points:
• Patients selected for ablation of small renal masses are older and have more comorbidities compared with those undergoing partial nephrectomy. • Partial nephrectomy yields lower all-cause mortality, which is probably biased by patient selection and does not translate into prolonged cancer-free survival. • The decline of renal function is smallest after radiofrequency ablation for small renal masses.
Insights
Partial nephrectomy (PN) and ablative therapies (radiofrequency ablation [RFA], cryoablation [CRA], microwave ablation [MWA]) show similar cancer-specific survival. Ablation offers better renal function preservation and fewer complications, particularly RFA.
Area of Science:
- Urology
- Oncology
- Minimally Invasive Surgery
Background:
- Partial nephrectomy (PN) and ablative therapies (radiofrequency ablation [RFA], cryoablation [CRA], microwave ablation [MWA]) are treatment options for small renal masses.
- Patient selection for PN often favors younger, healthier individuals compared to those undergoing ablation.
Purpose of the Study:
- To compare oncologic, perioperative, and functional outcomes of PN, RFA, CRA, and MWA for small renal masses.
- To evaluate mortality, local recurrence, complications, and renal function across these treatment modalities.
Main Methods:
- A systematic literature search of MEDLINE, EMBASE, and COCHRANE databases was conducted.
- Network meta-analyses were performed on data from 47 studies involving 24,077 patients comparing PN, RFA, CRA, and MWA.
Main Results:
- Patients undergoing ablation were older with more comorbidities than those receiving PN.
- While PN showed lower all-cause mortality, cancer-specific mortality did not differ significantly. Local recurrence was higher with ablative techniques.
- Radiofrequency ablation (RFA) demonstrated the least decline in renal function compared to PN, CRA, and MWA.
Conclusions:
- Despite higher overall survival and local control for PN, cancer-specific mortality benefits were not significant compared to ablative therapies.
- Patient selection bias in studies may inflate PN's apparent survival advantage.
- Ablative techniques, especially RFA, offer potential benefits in complication profile and renal function preservation for select patients.
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