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European Radiology
Published in: European Radiology 3/2019

01-03-2019 | Interventional

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

Authors: Johannes Uhlig, Arne Strauss, Gerta Rücker, Ali Seif Amir Hosseini, Joachim Lotz, Lutz Trojan, Hyun S. Kim, Annemarie Uhlig

Published in: European Radiology | Issue 3/2019

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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.
Appendix
Available only for authorised users
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Metadata
Title
Partial nephrectomy versus ablative techniques for small renal masses: a systematic review and network meta-analysis
Authors
Johannes Uhlig
Arne Strauss
Gerta Rücker
Ali Seif Amir Hosseini
Joachim Lotz
Lutz Trojan
Hyun S. Kim
Annemarie Uhlig
Publication date
01-03-2019
Publisher
Springer Berlin Heidelberg
Published in
European Radiology / Issue 3/2019
Print ISSN: 0938-7994
Electronic ISSN: 1432-1084
DOI
https://doi.org/10.1007/s00330-018-5660-3

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