Partial nephrectomy versus ablative techniques for small renal masses: a systematic review and network meta-analysis
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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.
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).
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.
• 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.
KeywordsKidney neoplasms Ablation techniques Nephrectomy Meta-analysis
Glomerular filtration rate
Incidence rate ratio
Annemarie Uhlig’s work was supported by a Ferdinand Eisenberger Grant of the Deutsche Gesellschaft für Urologie (German Society of Urology), grant ID UhA1/FE-17.
Compliance with ethical standards
The scientific guarantor of this publication is Annemarie Uhlig.
Conflict of interest
The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article.
Statistics and biometry
Three of the authors have significant statistical expertise.
Written informed consent was not required for this study because of the meta-analysis study design.
Institutional Review Board approval was not required because of the meta-analysis study design.
Study subjects or cohorts overlap
Study subjects or cohorts have been previously reported as detailed in the references.
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