Percutaneous Ablation is safe and has good long-term results in Small Renal Tumors

27.06.2018

Percutaneous ablation for small renal cell carcinoma (RCC) tumours in well-selected older patients may result in oncologic outcomes similar to those of radical nephrectomy, but with less long-term renal insufficiency and fewer perioperative complications, according to a new study.

In an observational study of 4310 patients aged 66 years or older who received treatment for renal tumors smaller than 4 cm (T1a RCC) from 2006 to 2011, the 5-year RCC-specific survival rate for patients who underwent percutaneous ablation (PA) and radical nephrectomy (RN) was 96% and 95%, respectively, a non-significant difference between treatment arms.

The 5-year RCC-specific survival rate was slightly lower for PA compared with partial nephrectomy (PN): 95% vs 98%.

The 5-year overall survival (OS) rates were similar for PA and RN (74% vs 75%) and lower for PA than PN (77% vs 86%).

In adjusted analyses, RCC-specific and all-cause mortality risk did not differ significantly between PA and RN. PA was associated with a non-significant 2-fold increased risk of RCC-specific mortality and a significant 2-fold increased risk of all-cause mortality compared with PN.

The cumulative rates of renal insufficiency 31 to 365 days after PA, PN, and RN were 11%, 9%, and 18%, respectively. Rates of non-urologic complications within 30 days after PA, PN, and RN were 6%, 29%, and 30%, respectively.

The authors concluded that appropriately selected older patients with small renal tumors may expect oncologic outcomes from PA similar to those of RN, with fewer complications and less chronic renal insufficiency. The comparability of oncologic outcomes for PA versus PN is less certain but patients who receive ablation might have fewer complications.

Reference

Talenfeld AD, Gennarelli RL, Elkin EB, et al. Percutaneous ablation versus partial and radical nephrectomy for T1a renal cancer. Ann Intern Med. 2018; published online ahead of print.