Ablation Appropriate for Small Renal Masses When Surgery Is Not an Option

Percutaneous ablation for small renal masses (SRM) results in acceptable functional outcomes with a lower perioperative complication rate compared with partial nephrectomy (PN), investigators suggested in a poster presentation at the 22nd annual meeting of the Society of Urologic Oncology.

Although percutaneous ablation is associated with higher disease recurrence and retreatment rates, it is an appropriate treatment option for patients with clinical T1a tumors who are not surgical candidates or those who opt for this procedure, said investigator Daniel Halstuch, MD, of Western University in London, Ontario, Canada, who presented study findings.

“Outcome differences, including renal function, complications, retreatment rates, and oncological outcomes, should be discussed in a shared decision-making process when counseling patients with small renal masses,” Dr Halstuch said.

The study included 269 men with cT1aN0M0 renal masses, of whom 112 and 157 underwent PN and percutaneous ablation, respectively. Among the patients who underwent ablation, 104 (66.2%) had radiofrequency ablation, 46 (29.3%) had cryoablation, and 7 (4.5%) had microwave ablation.

Compared with the ablation arm, the PN group was younger (58.6 vs 68.0 years), had a lower mean Charlson Comorbidity Index (3.82 vs 5.42), and higher mean preoperative estimated glomerular filtration rate (eGFR, 107.9 vs 86.0 mL/min/1.73 m²).

At a median follow-up duration of 27.7 months and 29.9 months, the recurrence rate after 3 months was 8.9% and 2.7% in the ablation and PN arms, respectively –a significant difference between the groups, Dr Halstuch and colleagues reported. They observed no significant difference in overall survival between the groups.

The postoperative decrease in eGFR was significantly lower in the ablation arm compared with the PN group (8.7 vs 18.7 mL/min/1.73 m²). The PN group had a significantly higher complication rate than the ablation group (31.3% vs 7.0%). In the ablation group, 19 patients required repeat procedures. Similar proportions of the ablation and PN groups required a nephrectomy (1.3% vs 1.8%).

Reference

Halstuch D, Sami S, Hetou K, et al. Percutaneous ablation versus partial nephrectomy for clinical T1a masses. Presented at the 22nd annual meeting of the Society of Urologic Oncology, December 1-3, 2021. Poster 87.