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Eur Radiol. 2019 Mar;29(3):1293-1307. doi: 10.1007/s00330-018-5660-3. Epub 2018 Sep 25.

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

Author information

1
Department of Diagnostic and Interventional Radiology, University Medical Center Goettingen, Goettingen, Germany.
2
Division of Interventional Radiology, Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, CT, USA.
3
Department of Urology, University Medical Center Goettingen, Robert-Koch-Strasse 40, 37075, Goettingen, Germany.
4
Faculty of Medicine and Institute of Medical Biometry and Statistics, Medical Center - University of Freiburg, Freiburg, Germany.
5
German Centre for Cardiovascular Research, Partnersite Goettingen, Goettingen, Germany.
6
Department of Urology, University Medical Center Goettingen, Robert-Koch-Strasse 40, 37075, Goettingen, Germany. annemarie.uhlig@med.uni-goettingen.de.

Abstract

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.

KEYWORDS:

Ablation techniques; Kidney neoplasms; Meta-analysis; Nephrectomy

PMID:
30255245
DOI:
10.1007/s00330-018-5660-3
[Indexed for MEDLINE]

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