Ablative therapies in the treatment of small renal tumors: How far from standard of care?

Objectives: To determine the current clinical value of minimally invasive thermoablative techniques (MI thermoablative T) to ablate small renal tumors through a literature review. Methods: A literature search was conducted on the most commonly used MI thermoablative T for small renal tumors, namely cryoablation (CA) and radiofrequency ablation (RFA). Primary objective was to carry out a comparative assessment of the complication rate, recurrence rate, and cancer specific survival rates across techniques. Secondary objective was to critically review technical aspects of the procedures. Results: Five-year follow-up data were available only for laparoscopic CA, with a recurrence rate varying from 0% to 15%. Follow-up of percutaneous cryoablation (PCA) and RFA did not go beyond 2 years, and excellent recurrence free rates were obtained at the price of a significant retreatment rate. The need for retreatment was perceived as lower with PCA than with RFA. Overall complication rate did not exceed 5% in all techniques albeit laparoscopic CA carried a significant degree of invasiveness compared with other percutaneous techniques. Conclusions: MI thermoablative T for small renal tumors should still be confined to carefully selected patients. PCA seems to hold the premises for the best compromise between low invasiveness and high efficacy, while RFA appears highly advantageous in terms of procedural costs. (C) 2010 Elsevier Inc. All rights reserved.