Top

CardioVascular and Interventional Radiology

Published in:

Open Access 01-11-2016 | Clinical Investigation

Percutaneous Radiofrequency Ablation Versus Robotic-Assisted Partial Nephrectomy for the Treatment of Small Renal Cell Carcinoma

Authors: Maria Pantelidou, Ben Challacombe, Andrew McGrath, Matthew Brown, Shahzad Ilyas, Konstantinos Katsanos, Andreas Adam

Published in: CardioVascular and Interventional Radiology | Issue 11/2016

Abstract

Introduction

The authors compared the oncologic outcomes of radiofrequency ablation (RFA) with robotic-assisted partial nephrectomy (RPN) for the treatment of T1 stage renal cell carcinoma (RCC).

Materials and methods

This was a retrospective data analysis of a high-volume single tertiary centre. Patients were treated with RFA or RPN following multidisciplinary decision making. Only histologically proven RCCs were included. Baseline demographics were collected, and PADUA scores of tumour features were calculated to standardize baseline anatomy. Peri-operative complications, kidney function and oncological outcomes were compared.

Results

Sixty-three cases were included in each group. Baseline renal function was poorer in RFA, and 16/63 RFA patients had tumours in single kidneys compared to 1/63 RPN cases (p < 0.001). Length of stay was shorter in RFA (1 vs. 3 days, p < 0.0001). Post-procedure renal function decline at 30 days was significantly less in RFA [(−0.8) ± 9.6 vs. (−16.1) ± 19.5 mls/min/1.73 m²; p < 0.0001]. More minor complications were recorded in RPN (10/63 vs. 4/63, p = 0.15), but local recurrence was numerically higher in RFA (6/63 vs. 1/63, p = 0.11). Disease-free survival (DFS) was not significantly different (adjusted HR = 0.6, 95 % Cl 0.1–3.7; p = 0.60). Increasing tumour size was an independent predictor of local recurrence (adjusted HR = 1.7; 95 % Cl 1.1–2.6 per cm; p = 0.02).

Conclusions

Both RPN and RFA offer very good oncological outcomes for the treatment of T1 RCC with low peri-operative morbidity and similar oncologic outcomes. RFA demonstrated fewer peri-operative complications and better preservation of renal function, whereas RPN had an insignificantly lower local recurrence rate. RFA should be offered alongside RPN for selected cases.

Katsanos K, Mailli L, Krokidis M, McGrath A, Sabharwal T, Adam A. Systematic review and meta-analysis of thermal ablation versus surgical nephrectomy for small renal tumours. Cardiovasc Intervent Radiol. 2014;37(2):427–37.CrossRefPubMed

Olweny EO, Park SK, Tan YK, Best SL, Trimmer C, Cadeddu JA. Radiofrequency ablation versus partial nephrectomy in patients with solitary clinical T1a renal cell carcinoma: comparable oncologic outcomes at a minimum of 5 years of follow-up. Eur Urol. 2012;61(6):1156–61.CrossRefPubMed

Whitson JM, Harris CR, Meng MV. Population-based comparative effectiveness of nephron-sparing surgery vs ablation for small renal masses. BJU Int. 2012;110(10):1438–43 (discussion 1443).CrossRefPubMed

Campbell SC, Novick AC, Belldegrun A, et al. Guideline for management of the clinical T1 renal mass. J Urol. 2009;182(4):1271–9.CrossRefPubMed

Ljungberg B, Hanbury DC, Kuczyk MA, et al. Renal cell carcinoma guideline. Eur Urol. 2007;51(6):1502–10.CrossRefPubMed

Thompson RH, Atwell T, Schmit G, et al. Comparison of partial nephrectomy and percutaneous ablation for cT1 renal masses. Eur Urol. 2015;67(2):252–9.CrossRefPubMed

Stern JM, Svatek R, Park S, et al. Intermediate comparison of partial nephrectomy and radiofrequency ablation for clinical T1a renal tumours. BJU Int. 2007;100(2):287–90.CrossRefPubMed

Djaladat H, Bruins HM, Miranda G, Cai J, Skinner EC, Daneshmand S. The association of preoperative serum albumin level and American Society of Anesthesiologists (ASA) score on early complications and survival of patients undergoing radical cystectomy for urothelial bladder cancer. BJU Int. 2014;113(6):887–93.CrossRefPubMed

Gohil R, Ahmed K, Kooiman G, Khan MS, Dasgupta P, Challacombe B. Current status of robot-assisted partial nephrectomy. BJU Int. 2012;110(11):1602–6.CrossRefPubMed

10.

Babbar P, Hemal AK. Robot-assisted partial nephrectomy: current status, techniques, and future directions. Int Urol Nephrol. 2012;44(1):99–109.CrossRefPubMed

11.

Mottrie A, De Naeyer G, Schatteman P, Carpentier P, Sangalli M, Ficarra V. Impact of the learning curve on perioperative outcomes in patients who underwent robotic partial nephrectomy for parenchymal renal tumours. Eur Urol. 2010;58(1):127–32.CrossRefPubMed

12.

Krokidis M, Spiliopoulos S, Jarzabek M, et al. Percutaneous radiofrequency ablation of small renal tumours in patients with a single functioning kidney: long-term results. Eur Radiol. 2013;23(7):1933–9.CrossRefPubMed

13.

Sabharwal T, Katsanos K, Buy X, Gangi A. Image-guided ablation therapy of bone tumors. Semin Ultrasound CT MR. 2009;30(2):78–90.CrossRefPubMed

14.

Hew MN, Baseskioglu B, Barwari K, et al. Critical appraisal of the PADUA classification and assessment of the R.E.N.A.L. nephrometry score in patients undergoing partial nephrectomy. J Urol. 2011;186(1):42–6.CrossRefPubMed

15.

Ficarra V, Novara G, Secco S, et al. Preoperative aspects and dimensions used for an anatomical (PADUA) classification of renal tumours in patients who are candidates for nephron-sparing surgery. Eur Urol. 2009;56(5):786–93.CrossRefPubMed

16.

Kobayashi K, Saito T, Kitamura Y, et al. The RENAL nephrometry score and the PADUA classification for the prediction of perioperative outcomes in patients receiving nephron-sparing surgery: feasible tools to predict intraoperative conversion to nephrectomy. Urol Int. 2013;91(3):261–8.CrossRefPubMed

17.

Mandal S, Sankhwar SN, Kathpalia R, et al. Grading complications after transurethral resection of prostate using modified Clavien classification system and predicting complications using the Charlson comorbidity index. Int Urol Nephrol. 2013;45(2):347–54.CrossRefPubMed

18.

Novick AC, Streem S, Montie JE, et al. () Conservative surgery for renal cell carcinoma: a single-center experience with 100 patients. J Urol (1989). 2002;167(2 Pt 2):878–82 (discussion 883).CrossRef

19.

Boylu U, Basatac C, Yildirim U, Onol FF, Gumus E. Comparison of surgical, functional, and oncological outcomes of open and robot-assisted partial nephrectomy. J Minim Access Surg. 2015;11(1):72–7.CrossRefPubMedPubMedCentral

20.

Benway BM, Bhayani SB. Surgical outcomes of robot-assisted partial nephrectomy. BJU Int. 2011;108(6 Pt 2):955–61.CrossRefPubMed

21.

Benway BM, Bhayani SB, Rogers CG, et al. Robot-assisted partial nephrectomy: an international experience. Eur Urol. 2010;57(5):815–20.CrossRefPubMed

22.

Hui GC, Tuncali K, Tatli S, Morrison PR, Silverman SG. Comparison of percutaneous and surgical approaches to renal tumor ablation: metaanalysis of effectiveness and complication rates. J Vasc Interv Radiol. 2008;19(9):1311–20.CrossRefPubMed

23.

Thumar AB, Trabulsi EJ, Lallas CD, Brown DB. Thermal ablation of renal cell carcinoma: triage, treatment, and follow-up. J Vasc Interv Radiol. 2010;21(8 Suppl):S233–41.CrossRefPubMed

24.

Froghi S, Ahmed K, Khan MS, Dasgupta P, Challacombe B. Evaluation of robotic and laparoscopic partial nephrectomy for small renal tumours (T1a). BJU Int. 2013;112(4):E322–33.CrossRefPubMed

25.

Takaki H, Yamakado K, Soga N, et al. Midterm results of radiofrequency ablation versus nephrectomy for T1a renal cell carcinoma. Jpn J Radiol. 2010;28(6):460–8.CrossRefPubMed

26.

Chang X, Zhang F, Liu T, et al. Radio Frequency Ablation versus Partial Nephrectomy for Clinical T1b Renal Cell Carcinoma: long-Term Clinical and Oncologic Outcomes. J Urol. 2015;193(2):430–5.CrossRefPubMed

Title: Percutaneous Radiofrequency Ablation Versus Robotic-Assisted Partial Nephrectomy for the Treatment of Small Renal Cell Carcinoma
Authors: Maria Pantelidou
Ben Challacombe
Andrew McGrath
Matthew Brown
Shahzad Ilyas
Konstantinos Katsanos
Andreas Adam
Publication date: 01-11-2016
Publisher: Springer US
Published in: CardioVascular and Interventional Radiology / Issue 11/2016
Print ISSN: 0174-1551
Electronic ISSN: 1432-086X
DOI: https://doi.org/10.1007/s00270-016-1417-z

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Percutaneous Radiofrequency Ablation Versus Robotic-Assisted Partial Nephrectomy for the Treatment of Small Renal Cell Carcinoma

Abstract

Introduction

Materials and methods

Results

Conclusions

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Introduction

Materials and methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 11/2016

Impact and Effectiveness of Dual Aspiration Technique in Stent-Assisted Mechanical Thrombectomy: Recent Improvements in Acute Stroke Management

Unresectable Hepatocellular Carcinoma: Radioembolization Versus Chemoembolization: A Systematic Review and Meta-analysis

Pseudoaneurysm: Some Differences in its Character Between the Mesenteric vs. Uterine Artery Highlighting the Unique Feature of This Vascular Disorder

Irreversible Electroporation of Prostate Cancer: Patient-Specific Pretreatment Simulation by Electric Field Measurement in a 3D Bioprinted Textured Prostate Cancer Model to Achieve Optimal Electroporation Parameters for Image-Guided Focal Ablation

Management of Suprahepatic Inferior Vena Cava Obstruction

Pseudoaneurysm: Some Differences in its Character Between the Mesenteric vs. Uterine Artery Highlighting the Unique Feature of This Vascular Disorder: Comments