Evaluation of local control after percutaneous microwave ablation versus partial nephrectomy: A propensity score matched study

Minimally Invasive Salvage Approaches for Management of Recurrence After Primary Renal Mass Ablation

Objectives: Thermal ablation has emerged as an effective, nephron-sparing treatment for small renal masses (SRMs), particularly in patients with comorbidities. However, tumor recurrence remains a challenge, necessitating evidence-based approaches for salvage management. This review examines the outcomes of minimally invasive modalities for managing recurrence following the primary ablation of SRMs. Methods: A literature review was conducted using the Medline database, following PRISMA guidelines. Studies published between 1981 and 2024 were screened based on predefined PICO criteria. Inclusion focused on patients with tumor recurrence after primary ablation therapy who underwent minimally invasive salvage treatments including repeat ablation, laparoscopic/robotic partial or radical nephrectomy, or active surveillance. Data extracted included patient demographics, initial treatments, recurrence timelines, salvage modalities, and outcomes. Results: Of 364 patients across 29 studies, 249 (68.4%) underwent re-ablation, 82 (22.5%) were treated with laparoscopic/robotic partial or radical nephrectomy, and 33 (9%) were managed with active surveillance. Among 249 patients with re-ablation, 179 (71.9%) showed no evidence of disease, 67 (26.9%) experienced recurrence, and outcomes were indeterminate in 3 (1.2%). Salvage minimally invasive partial or radical nephrectomy outcomes were available for 64 cases, with 63 (98.4%) showing no recurrence. In 33 patients under active surveillance, 4 died, 4 underwent surgery, and 25 remained under monitoring, though follow-up data were limited. Conclusion: Minimally invasive salvage modalities, such as re-ablation and laparoscopic/robotic partial or radical nephrectomy, effectively manage tumor recurrence, achieving >70% and >98% oncological success, respectively, despite technical challenges. Future studies directly comparing these modalities are essential for establishing standardized protocols for salvage management.

Percutaneous Microwave Ablation Versus Robot-Assisted Partial Nephrectomy for Stage I Renal Cell Carcinoma: A Propensity-Matched Cohort Study Focusing Upon Long-Term Follow-Up of Oncologic Outcomes

PURPOSE

To retrospectively compare long-term oncologic outcomes of percutaneous computed tomography-guided microwave ablation (MWA) and robot-assisted partial nephrectomy (RAPN) for the treatment of stage 1 (T1a and T1b) renal cell carcinoma (RCC) patients.

MATERIALS AND METHODS

Institutional database research identified all T1 RCC patients who underwent either MWA or RAPN. Models were adjusted with propensity score matching. Kaplan-Meier log-rank test analyses and Cox proportional hazard regression models were used to compare the oncologic outcomes. Patient and tumor characteristics, technical success as well as oncologic outcomes were evaluated and compared between the 2 groups.

RESULTS

After propensity score matching, a total of 71 patients underwent percutaneous MWA (mean age 70 ± 10 years) and 71 underwent RAPN (mean age 60 ± 9 years). At 8-year follow-up, the estimated survival rates for MWA cohort were 98% (95% confidence interval [CI] 95-100%) for overall survival, 97% (95% CI 93-100%) for recurrence-free survival, and 97% (95% CI 93-100%) for metastasis-free survival. The matched cohort that underwent RAPN exhibited survival rates of 100% (95% CI 100-100%) for overall survival, 98% (95% CI 94-100%) for recurrence-free survival, and 98% (95% CI 94-100%) for metastasis-free survival. After performing log-rank testing, these rates were not significantly different (p values of 0.44, 0.67, and 0.67, respectively).

CONCLUSION

The results of the present study suggest that both MWA and RAPN are equally effective in terms of oncologic outcome for the treatment of T1 RCC.