TY - JOUR
T1 - Focal ablation therapy for renal cancer in the era of active surveillance and minimally invasive partial nephrectomy
AU - Ginzburg, Serge
AU - Tomaszewski, Jeffrey
AU - Kutikov, Alexander
PY - 2017/9/12
Y1 - 2017/9/12
N2 - Partial nephrectomy is the optimal surgical approach in the management of small renal masses (SRMs). Focal ablation therapy has an established role in the modern management of SRMs, especially in elderly patients and those with comorbidities. Percutaneous ablation avoids general anaesthesia and laparoscopic ablation can avoid excessive dissection; hence, these techniques can be suitable for patients who are not ideal surgical candidates. Several ablation modalities exist, of which radiofrequency ablation and cryoablation are most widely applied and for which safety and oncological efficacy approach equivalency to partial nephrectomy. Data supporting efficacy and safety of ablation techniques continue to mature, but they originate in institutional case series that are confounded by cohort heterogeneity, selection bias, and lack of long-term follow-up periods. Image guidance and surveillance protocols after ablation vary and no consensus has been established. The importance of SRM biopsy, its optimal timing, the type of biopsy used, and its role in treatment selection continue to be debated. As safety data for active surveillance and experience with minimally invasive partial nephrectomy are expanding, the role of focal ablation therapy in the treatment of patients with SRMs requires continued evaluation.
AB - Partial nephrectomy is the optimal surgical approach in the management of small renal masses (SRMs). Focal ablation therapy has an established role in the modern management of SRMs, especially in elderly patients and those with comorbidities. Percutaneous ablation avoids general anaesthesia and laparoscopic ablation can avoid excessive dissection; hence, these techniques can be suitable for patients who are not ideal surgical candidates. Several ablation modalities exist, of which radiofrequency ablation and cryoablation are most widely applied and for which safety and oncological efficacy approach equivalency to partial nephrectomy. Data supporting efficacy and safety of ablation techniques continue to mature, but they originate in institutional case series that are confounded by cohort heterogeneity, selection bias, and lack of long-term follow-up periods. Image guidance and surveillance protocols after ablation vary and no consensus has been established. The importance of SRM biopsy, its optimal timing, the type of biopsy used, and its role in treatment selection continue to be debated. As safety data for active surveillance and experience with minimally invasive partial nephrectomy are expanding, the role of focal ablation therapy in the treatment of patients with SRMs requires continued evaluation.
KW - Ablation Techniques
KW - Humans
KW - Kidney Neoplasms/pathology
KW - Minimally Invasive Surgical Procedures
KW - Nephrectomy
UR - http://www.scopus.com/inward/record.url?scp=85032674227&partnerID=8YFLogxK
UR - https://doi.org/10.1038/nrurol.2017.143
U2 - 10.1038/nrurol.2017.143
DO - 10.1038/nrurol.2017.143
M3 - Review article
C2 - 28895562
SN - 1759-4812
VL - 14
SP - 669
EP - 682
JO - Nature Reviews Urology
JF - Nature Reviews Urology
IS - 11
ER -