Abstract
The widespread utilization of abdominal imaging has led to an increase in incidentally detected small renal masses. Although partial nephrectomy is still considered the gold standard treatment for these masses, there are risks associated with surgical excision, potentially limiting treatment for older patients with multiple comorbidities. A variety of ablative techniques have developed over the past several decades, altering the management of small renal masses. It is likely that improvements in technology will only broaden the applications of ablative therapy. This article provides an update on the various ablative techniques and outcomes.
Similar content being viewed by others
References
Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance
Richard PO et al. Renal tumor biopsy for small renal masses: a single-center 13-year experience. Eur Urol. 2015;68(6):1007–13.
Zargar H et al. Laparoscopic vs percutaneous cryoablation for the small renal mass: 15-year experience at a single center. Urology. 2015;85(4):850–5.
Campbell SC et al. Guideline for management of the clinical T1 renal mass. J Urol. 2009;182(4):1271–9.
Hollingsworth JM et al. Rising incidence of small renal masses: a need to reassess treatment effect. J Natl Cancer Inst. 2006;98(18):1331–4.
Winokur RS, Pua BB, Madoff DC. Role of combined embolization and ablation in management of renal masses. Semin Interv Radiol. 2014;31(1):82–5.
Schmit GD et al. ABLATE: a renal ablation planning algorithm. AJR Am J Roentgenol. 2014;202(4):894–903.
Desai MM, Aron M, Gill IS. Laparoscopic partial nephrectomy versus laparoscopic cryoablation for the small renal tumor. Urology. 2005;66(5 Suppl):23–8.
Lucas SM et al. Renal function outcomes in patients treated for renal masses smaller than 4 cm by ablative and extirpative techniques. J Urol. 2008;179(1):75–9.
Woldu SL et al. Comparison of renal parenchymal volume preservation between partial nephrectomy, cryoablation, and radiofrequency ablation using 3D volume measurements. J Endourol. 2015;29(8):948–55.
Woldrich JM et al. Trends in the surgical management of localized renal masses: thermal ablation, partial and radical nephrectomy in the USA, 1998-2008. BJU Int. 2013;111(8):1261–8.
Gervais DA. Cryoablation versus radiofrequency ablation for renal tumor ablation: time to reassess? J Vasc Interv Radiol. 2013;24(8):1135–8.
Rodriguez Faba O, et al. Current status of focal cryoablation for small renal masses. Urology. 2015. 11(41).
Baust JG et al. Mechanisms of cryoablation: clinical consequences on malignant tumors 2014. Cryobiology. 2014;68(1):1–11. doi:10.1016/j.cryobiol.2013.11.001.
Ge BH et al. Percutaneous renal cryoablation: short-axis ice-ball margin as a predictor of outcome. J Vasc Interv Radiol. 2016;27(3):403–9.
Klossner DP et al. Cryosurgical technique: assessment of the fundamental variables using human prostate cancer model systems. Cryobiology. 2007;55(3):189–99.
Kim EH et al. Comparison of laparoscopic and percutaneous cryoablation for treatment of renal masses. Urology. 2014;83(5):1081–7.
Hong K, Georgiades C. Radiofrequency ablation: mechanism of action and devices. J Vasc Interv Radiol. 2010;21(8 Suppl):008.
Goldberg SN et al. Radiofrequency tissue ablation: increased lesion diameter with a perfusion electrode. Acad Radiol. 1996;3(8):636–44.
Lubner MG et al. Microwave tumor ablation: mechanism of action, clinical results, and devices. J Vasc Interv Radiol. 2010;21(8 Suppl):007.
Gehl J. Electroporation: theory and methods, perspectives for drug delivery, gene therapy and research. Acta Physiol Scand. 2003;177(4):437–47.
Rubinsky J et al. Optimal parameters for the destruction of prostate cancer using irreversible electroporation. J Urol. 2008;180(6):2668–74.
Trimmer CK et al. Minimally invasive percutaneous treatment of small renal tumors with irreversible electroporation: a single-center experience. J Vasc Interv Radiol. 2015;26(10):1465–71. This is the largest study suggesting efficacy of IRE, a new technology which may had some advantages over thermal ablation due to a lack of a heat sink effect of surrounding structures.
Neal 2nd RE et al. In vivo irreversible electroporation kidney ablation: experimentally correlated numerical models. IEEE Trans Biomed Eng. 2015;62(2):561–9.
Matin SF et al. Residual and recurrent disease following renal energy ablative therapy: a multi-institutional study. J Urol. 2006;176(5):1973–7.
Donat SM et al. Follow-up for clinically localized renal neoplasms: AUA Guideline. J Urol. 2013;190(2):407–16.
Regier M, Chun F. Thermal ablation of renal tumors: indications, techniques and results. Dtsch Arztebl Int. 2015;112(24):412–8.
Nielsen TK et al. Computed tomography contrast enhancement following renal cryoablation—does it represent treatment failure? J Endourol. 2015;29(12):1353–60.
Psutka SP et al. Long-term oncologic outcomes after radiofrequency ablation for T1 renal cell carcinoma. Eur Urol. 2013;63(3):486–92. This long follow up of RFA patient reveals good LRFS and CSS at a median of 6.5 years.
Olweny EO et al. Radiofrequency ablation versus partial nephrectomy in patients with solitary clinical T1a renal cell carcinoma: comparable oncologic outcomes at a minimum of 5 years of follow-up. Eur Urol. 2012;61(6):1156–61.
Caputo PA et al. Laparoscopic cryoablation for renal cell carcinoma: 100-month oncologic outcomes. J Urol. 2015;194(4):892–6. This is the longest follow up assessing oncologic outcomes for cryoablation, finding a 10 year CSS of 93%.
Thompson RH et al. Comparison of partial nephrectomy and percutaneous ablation for cT1 renal masses. Eur Urol. 2015;67(2):252–9. In this comparison of partial nephrectomy and thermal ablation of SRMs, a high LRFS was seen across all groups, suggesting similar oncologic outcomes between surgical and ablative therapies.
Gahan JC et al. The performance of a modified RENAL nephrometry score in predicting renal mass radiofrequency ablation success. Urology. 2015;85(1):125–9.
Kutikov A, Uzzo RG. The R.E.N.A.L. nephrometry score: a comprehensive standardized system for quantitating renal tumor size, location and depth. J Urol. 2009;182(3):844–53.
Best SL et al. Long-term outcomes of renal tumor radio frequency ablation stratified by tumor diameter: size matters. J Urol. 2012;187(4):1183–9.
Lay AH et al. Oncologic efficacy of radio frequency ablation for small renal masses: clear cell vs papillary subtype. J Urol. 2015;194(3):653–7.
Lay AH et al. Likelihood of incomplete kidney tumor ablation with radiofrequency energy: degree of enhancement matters. J Urol. 2016;27(16):00204–4.
Castle SM, Salas N, Leveillee RJ. Initial experience using microwave ablation therapy for renal tumor treatment: 18-month follow-up. Urology. 2011;77(4):792–7.
Moreland AJ et al. High-powered microwave ablation of t1a renal cell carcinoma: safety and initial clinical evaluation. J Endourol. 2014;28(9):1046–52. This manuscript is the first and largest study to evaluate microwave ablation for the treatment of t1a tumors with improved technology. Out of the 55 tumors ablated, no disease progression was seen at 8 months.
Yu J et al. US-guided percutaneous microwave ablation versus open radical nephrectomy for small renal cell carcinoma: intermediate-term results. Radiology. 2014;270(3):880–7.
Olweny EO, Cadeddu JA. Novel methods for renal tissue ablation. Curr Opin Urol. 2012;22(5):379–84.
Tracy CR, Kabbani W, Cadeddu JA. Irreversible electroporation (IRE): a novel method for renal tissue ablation. BJU Int. 2011;107(12):1982–7.
Pech M et al. Irreversible electroporation of renal cell carcinoma: a first-in-man phase I clinical study. Cardiovasc Intervent Radiol. 2011;34(1):132–8.
Mir MC et al. Parenchymal volume preservation and ischemia during partial nephrectomy: functional and volumetric analysis. Urology. 2013;82(2):263–8.
Ji C et al. Laparoscopic radiofrequency ablation versus partial nephrectomy for cT1a renal tumors: long-term outcome of 179 patients. Urol Int. 2016;19:19.
Wehrenberg-Klee E et al. Impact on renal function of percutaneous thermal ablation of renal masses in patients with preexisting chronic kidney disease. J Vasc Interv Radiol. 2012;23(1):41–5.
Karam JA et al. Salvage surgery after energy ablation for renal masses. BJU Int. 2015;115(1):74–80.
Jimenez JA et al. Surgical salvage of thermal ablation failures for renal cell carcinoma. J Urol. 2016;195(3):594–600.
Okhunov Z et al. R.E.N.A.L. nephrometry score accurately predicts complications following laparoscopic renal cryoablation. J Urol. 2012;188(5):1796–800.
Farrell MA et al. Imaging-guided radiofrequency ablation of solid renal tumors. AJR Am J Roentgenol. 2003;180(6):1509–13.
Atwell TD et al. Complications following 573 percutaneous renal radiofrequency and cryoablation procedures. J Vasc Interv Radiol. 2012;23(1):48–54.
Balageas P et al. Ten-year experience of percutaneous image-guided radiofrequency ablation of malignant renal tumours in high-risk patients. Eur Radiol. 2013;23(7):1925–32.
Dirkmann D et al. Hypothermia and acidosis synergistically impair coagulation in human whole blood. Anesth Analg. 2008;106(6):1627–32.
Larcher A et al. Long-term oncologic outcomes of laparoscopic renal cryoablation as primary treatment for small renal masses. Urol Oncol. 2015;33(1):7.
Wah TM et al. Radiofrequency ablation (RFA) of renal cell carcinoma (RCC): experience in 200 tumours. BJU Int. 2014;113(3):416–28.
Gervais DA et al. Radiofrequency ablation of renal cell carcinoma: part 1, indications, results, and role in patient management over a 6-year period and ablation of 100 tumors. AJR Am J Roentgenol. 2005;185(1):64–71.
Hui GC et al. Comparison of percutaneous and surgical approaches to renal tumor ablation: metaanalysis of effectiveness and complication rates. J Vasc Interv Radiol. 2008;19(9):1311–20.
Zargar H et al. Cryoablation for small renal masses: selection criteria, complications, and functional and oncologic results. Eur Urol. 2016;69(1):116–28.
Breen DJ et al. Percutaneous cryoablation of renal tumours: outcomes from 171 tumours in 147 patients. BJU Int. 2013;112(6):758–65.
Chen JX et al. Complication and readmission rates following same-day discharge after percutaneous renal tumor ablation. J Vasc Interv Radiol. 2016;27(1):80–6.
Seideman CA et al. Renal tumour nephrometry score does not correlate with the risk of radiofrequency ablation complications. BJU Int. 2013;112(8):1121–4.
Bai J et al. Initial experience with retroperitoneoscopic microwave ablation of clinical T(1a) renal tumors. J Endourol. 2010;24(12):2017–22.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of Interest
Nicholas Kavoussi, Noah Canvasser, and Jeffrey Caddedu each declare no potential conflicts of interest.
Human and Animal Rights and Informed Consent
This article does not contain any studies with human or animal subjects performed by any of the authors.
Additional information
This article is part of the Topical Collection on New Imaging Techniques
Rights and permissions
About this article
Cite this article
Kavoussi, N., Canvasser, N. & Caddedu, J. Ablative Therapies for the Treatment of Small Renal Masses: a Review of Different Modalities and Outcomes. Curr Urol Rep 17, 59 (2016). https://doi.org/10.1007/s11934-016-0611-5
Published:
DOI: https://doi.org/10.1007/s11934-016-0611-5