Advocating laparoscopic radiofrequency ablation as an optimal treatment for small renal cell carcinoma in special patient populations

We have written a letter to support the widespread recognition and adoption of laparoscopic radiofrequency ablation (RFA) as an innovative and effective surgical method for the treatment of small renal cell carcinoma in patients who face unique challenges due to very old age, poor general condition, or being unable to receive blood transfusions for religious reasons. Traditional surgical approaches, such as open partial nephrectomy or radical nephrectomy, have been the cornerstone of treatment for localized renal cell carcinoma. However, these procedures are often associated with extensive invasiveness, prolonged hospital stays, and prolonged recovery periods, leading to potential complications and reduced quality of life for patients. Recent advances in robot-assisted partial nephrectomy (RAPN) have made the procedure less invasive and have dramatically reduced the operative time and recovery period; however, the time and risk required to detach the renal pedicle, the risk for intraoperative and postoperative bleeding, and the need for blood transfusion cannot be completely eliminated in RAPN cases. Laparoscopic RFA has emerged as a transformative alternative for managing small renal tumors. This procedure involves guiding a radiofrequency probe through small incisions using a laparoscope, which delivers radiofrequency energy to the tumor site, inducing coagulative necrosis while preserving healthy kidney tissue [1].

Our initial publication on clinical research regarding laparoscopic RFA, titled “Comparison of laparoscopic radiofrequency ablation and open partial nephrectomy in patients with a small renal mass,” revealed that laparoscopic RFA yielded comparable oncological outcomes and overall survival rates to open partial nephrectomy for small renal masses [2]. Remarkably, laparoscopic RFA offered distinct advantages, including significantly lower complication rates, shorter operative times, and reduced hospital stays, making it an appealing alternative to traditional open surgery for eligible patients. Through subsequent cohort studies, we have come to firmly believe that laparoscopic RFA is an innovative approach in managing T1a renal masses, providing patients with remarkable oncologic outcomes and improved quality of life [3]. Park et al. [4] reported a growing recognition and endorsement of laparoscopic RFA for small renal masses. These guidelines represent a comprehensive evaluation of current evidence and expert consensus, providing valuable recommendations for health care providers and patients. The procedure’s safety and efficacy have garnered consistent support from various clinical trials and studies, validating the position of the procedure as an innovative and patient-centered approach to renal cell carcinoma management. A meta-analysis by Li et al. [5] found that RFA had similar oncological outcomes and overall survival rates compared with partial nephrectomy for small renal masses. Additionally, RFA demonstrated significantly lower complication rates, shorter operative times, and reduced hospital stays, making it a compelling alternative to traditional surgery for eligible patients.

Several key advantages of laparoscopic RFA make it a compelling choice for the treatment of small renal cell carcinoma:

1. Minimally invasive: Laparoscopic RFA enables surgery to be performed with only three ports in most cases, including a camera port and two 5-mm ports. The smaller incisions result in reduced pain, less blood loss, and a lower risk for infection. Patients experience shorter hospital stays and quicker recovery times, allowing them to resume their normal activities sooner.

2. Suitable for high-risk patients: Some patients with small renal tumors may be considered unfit for major surgery because of age, comorbidities, or other health concerns. Laparoscopic RFA provides a viable option for these high-risk patients, offering a potentially curative treatment with lower perioperative risks compared with conventional surgery.

3. Repeatable and salvageable: In cases where tumors recur or new lesions appear, laparoscopic RFA can be repeated. The ability to perform RFA multiple times without compromising future treatment options makes it an attractive choice for long-term cancer management.

4. Cost-effectiveness: Minimally invasive procedures typically result in reduced health care costs due to shorter hospital stays, faster recovery times, and lower surgical costs. Laparoscopic RFA can potentially alleviate the financial burden on patients and health care systems.

In conclusion, laparoscopic RFA represents a transformative approach in the surgical management of small renal cell carcinoma. Its minimally invasive nature, ability to preserve the kidney, suitability for high-risk patients, repeatability, and cost-effectiveness make it a compelling option that warrants broader recognition and adoption. By embracing laparoscopic RFA for patients with special cases or circumstances, we can improve patient outcomes, enhance quality of life, and redefine the treatment of small renal cell carcinoma.