CardioVascular and Interventional Radiology

, Volume 37, Issue 2, pp 427–437 | Cite as

Systematic Review and Meta-Analysis of Thermal Ablation Versus Surgical Nephrectomy for Small Renal Tumours

  • K. Katsanos
  • L. Mailli
  • M. Krokidis
  • A. McGrath
  • T. Sabharwal
  • A. Adam
Clinical Investigation

Abstract

Purpose

A systematic review was undertaken to provide a meta-analysis of clinical trials comparing thermal ablation with surgical nephrectomy for small renal tumours.

Methods

PubMed (MEDLINE), EMBASE, AMED, and Scopus were searched in August 2013 for eligible prospective or retrospective comparative trials following the PRISMA selection process. Thermal ablation was compared with surgical nephrectomy. Quality of included studies was assessed on the Newcastle-Ottawa Scale (NOS). The primary endpoint was disease-free survival and was analyzed on the log-hazard scale. Secondary outcome measures included complications, local recurrence, and decline of renal function. Hazard ratios (HR) and risk ratios (RR) were calculated with a random effects model, and meta-regression analysis was performed to explore clinical heterogeneity.

Results

Six clinical trials (1 randomized and 5 cohort; 6–8 stars on the NOS scale) involving 587 patients with small renal tumors (mean size 2.5 cm) treated with either thermal ablation (percutaneous or laparoscopic application of radiofrequency or microwave) or surgical nephrectomy (open or laparoscopic) were analyzed. Overall complication rate was significantly lower in the ablation group (7.4 vs. 11 %; RR: 0.55, 95 % confidence interval [CI]: 0.31–0.97, p = 0.04). Postoperative decline of eGFR was higher in case of nephrectomy (mean difference: −14.6 ml/min/1.73 m2, 95 % CI: −27.96 to −1.23, p = 0.03). Local recurrence rate was the same in both groups (3.6 vs. 3.6 %; RR: 0.92, 95 % CI: 0.4–2.14, p = 0.79) and disease-free survival also was similar up to 5 years (HR: 1.04, 95 % CI: 0.48–2.24, p = 0.92).

Conclusions

Thermal ablation of small renal masses produces oncologic outcomes similar to surgical nephrectomy and is associated with significantly lower overall complication rates and a significantly less decline of renal function. More randomized, controlled trials are necessary.

Keywords

Renal cancer Nephrectomy Ablation Meta-analysis 

Abbreviations

RCC

Renal cell carcinoma

RFA

Radiofrequency ablation

MWA

Microwave ablation

RCT

Randomized controlled Trial

PN

Partial nephrectomy

CT

Computed tomography

MRI

Magnetic resonance imaging

eGFR

Estimated glomerular filtration rate

DFS

Disease-free survival

HR

Hazard ratio

RR

Risk ratio

CI

Confidence interval

M–H

Mantel–Haenszel

D-L

DerSimonian and Laird

NOS

Newcastle-Ottawa scale

PRISMA

Preferred Reporting Items for Systematic reviews and Meta-analyses

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Copyright information

© Springer Science+Business Media New York and the Cardiovascular and Interventional Radiological Society of Europe (CIRSE) 2014

Authors and Affiliations

  • K. Katsanos
    • 1
  • L. Mailli
    • 1
  • M. Krokidis
    • 2
  • A. McGrath
    • 1
  • T. Sabharwal
    • 1
  • A. Adam
    • 1
  1. 1.Department of Interventional RadiologyGuy’s and St. Thomas’ Hospitals, NHS Foundation Trust, King’s Health PartnersLondonUK
  2. 2.Department of Interventional RadiologyAddenbrooke’s Hospital, Cambridge University Hospitals NHS Foundation TrustCambridgeUK

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