Partial nephrectomy Vs. Percutaneous thermal ablation of small renal masses

Percutaneous thermal ablation (TA), partial nephrectomy (PN), and active surveillance with delayed intervention in tumors smaller than 3 cm are the recommended treatments for small renal masses (SRMs). In this study, we investigated the post-operative course and the long-term oncological results of TA and PN, to identify the best candidates for each technology.

Patients with SRMs underwent either TA (77 patients) or PN (100 patients), according to surgeon and patient preferences. TA patients were significantly older (67.4 years ±0.2 vs. 60.0 years ±12, p < 0.01), sicker (Charlson comorbidity index of 0.85±36 vs. 0.39±0.94, p < 0.01), and their tumors were smaller by an average of 3 mm.

TA was associated with significantly shorter hospital stay (1.9 days ±0.4 vs. 5.5 days ±3.2, p < 0.01), smaller burden of treatment score (13.4 ± 6.7 vs. 26.9 ± 7.5, p < 0.01) and fewer complications. The 5-year recurrence-free survival rates after a single TA intervention and after PN were 83.5 % and 98.1 %, respectively (p < 0.01). The 5-year recurrence-free survival rate after TA was dependent on tumor diameter (100 % in tumors < 2.4 cm and 58.4 % in tumors 2.4-4 cm, p < 0.01) and independent of tumor diameter after PN.

TA is an effective treatment for kidney tumors smaller than 2.4 cm. Compared to PN, it provides the benefits of shorter hospitalization, lower burden of treatment, fewer complications, and excellent recurrence-free status after a single intervention. This finding suggests that 2.4 cm and not 3 cm may be the preferred cutoff for converting from active surveillance to active treatment. PN is the preferred treatment for patients with tumors>2.4 cm.