Partial nephrectomy versus ablative techniques for small renal masses: a systematic review and network meta-analysis.

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.