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  • Review Article
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Focal ablation therapy for renal cancer in the era of active surveillance and minimally invasive partial nephrectomy

Nature Reviews Urology volume 14, pages 669–682 (2017)Cite this article

Subjects

Key Points

  • Partial nephrectomy remains the optimal treatment for the management of small renal masses (SRMs), but several focal ablative techniques also exist, of which radiofrequency ablation and cryoablation are most commonly used

  • Ablative techniques continue to be a viable treatment option for SRMs, especially in elderly patients and those with comorbidities; however, active surveillance should be strongly considered as an alternative option

  • Ablative techniques seem to result in favourable short-term and intermediate-term complication rates and approach oncological and functional efficacy equivalent to partial nephrectomy in T1a SRMs; however, repeat ablation can be required and long-term follow-up data are lacking

  • The newest data suggest that ablative techniques are inferior to surgery for stage T1b tumours and long-term outcome data of ablative techniques continue to mature

Abstract

Partial nephrectomy is the optimal surgical approach in the management of small renal masses (SRMs). Focal ablation therapy has an established role in the modern management of SRMs, especially in elderly patients and those with comorbidities. Percutaneous ablation avoids general anaesthesia and laparoscopic ablation can avoid excessive dissection; hence, these techniques can be suitable for patients who are not ideal surgical candidates. Several ablation modalities exist, of which radiofrequency ablation and cryoablation are most widely applied and for which safety and oncological efficacy approach equivalency to partial nephrectomy. Data supporting efficacy and safety of ablation techniques continue to mature, but they originate in institutional case series that are confounded by cohort heterogeneity, selection bias, and lack of long-term follow-up periods. Image guidance and surveillance protocols after ablation vary and no consensus has been established. The importance of SRM biopsy, its optimal timing, the type of biopsy used, and its role in treatment selection continue to be debated. As safety data for active surveillance and experience with minimally invasive partial nephrectomy are expanding, the role of focal ablation therapy in the treatment of patients with SRMs requires continued evaluation.

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Figure 1: Cryoablation of a small renal mass.

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Acknowledgements

Alexander Kutikov received support through the NHI/NCI Cancer Center Support Grant P30 CA006927.

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Authors and Affiliations

  1. Division of Urologic Oncology, Department of Surgical Oncology, Fox Chase Cancer Center, 333 Cottman Avenue, Philadelphia, 19115, Philadelphia, USA

    Serge Ginzburg & Alexander Kutikov

  2. Department of Urology, Einstein Healthcare Network, 5501 Old York Road, Philadelphia, 19141, Philadelphia, USA

    Serge Ginzburg

  3. Division of Urology, MD Anderson Cancer Center at Cooper, 3 Cooper Plaza, Camden, 08103, New Jersey, USA

    Jeffrey J. Tomaszewski

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  1. Serge Ginzburg
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  3. Alexander Kutikov
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All authors researched data for the article and made substantial contributions to discussion of its content. All authors wrote and reviewed and/or edited the manuscript before submission.

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Correspondence to Serge Ginzburg.

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Ginzburg, S., Tomaszewski, J. & Kutikov, A. Focal ablation therapy for renal cancer in the era of active surveillance and minimally invasive partial nephrectomy. Nat Rev Urol 14, 669–682 (2017). https://doi.org/10.1038/nrurol.2017.143

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