Background: Ablative techniques emerged as effective alternative to nephron-sparing surgery for treatment of small renal masses. Radiofrequency ablation (RFA) and cryoablation (CRYO) are the two guidelines-recommended techniques. Microwave ablation (MWA) represents a newer technology, less described. Aim of the study was to compare outcomes of MWA to those of CRYO and RFA. Methods: Retrospective investigation of patients who underwent MWA, CRYO, or RFA from seven high-volume US and European centers was performed. The first group included patients who underwent CRYO or RFA; the second MWA. We collected baseline characteristics, clinical, intraoperative and post-operative data. Oncological data included technical success, local recurrence, and progression to metastasis. Multivariate analysis was performed to find predictors for postoperative complications. A composite outcome of "trifecta" was used to assess surgical, functional, and oncological outcomes. Results: 739 patients underwent CRYO or RFA and 50 MWA. CRYO/RFA group had significantly longer operative time (p<.001), but no difference in LOS, post-procedural Hb mean, intra-procedural complications (p=0.180), overall post-procedural complication rates (p=0.126), and in the 30-day re-admission rate (p=0.853) were detected. No predictive parameter of postprocedural complications was found. Concerning functional outcome no differences were detected in terms of eGFR at 1yr (p=0.182), ΔeGFR at 1-yr (p= 0.825) and eGFR at latest follow-up (p=0.070). "Technical success" was achieved in 98.6% of the cases (MWA= 100%, CRYO/RFA= 98.5%; p=0.775), and there was no significant difference in terms of 2-yr recurrence rate (p= 0.114) and metastatic progression (p= 0.203). Trifecta was achieved in 73.0% of CRYO/RFA vs 69.6% of MWA cases (p = 0.719). Conclusions: MWA is a safe and effective treatment option for small renal masses. Compared with CRYO/RFA, it seems to offer low complication rates, shorter operation time, and equivalent surgical and functional outcomes.
Microwave versus cryoablation and radiofrequency ablation for small renal mass: a multicenter comparative analysis / Pandolfo, Savio D; Carbonara, Umberto; Beksac, Alp T; Derweesh, Ithaar; Celia, Antonio; Schiavina, Riccardo; Elbich, Jeffrey; Basile, Giuseppe; Hampton, Lance J; Cerrato, Clara; Costa, Giovanni; Bianchi, Lorenzo; Lucarelli, Giuseppe; Mirone, Vincenzo; Imbimbo, Ciro; Kim, Fernando J; Del Giudice, Francesco; Capitanio, Umberto; Kaouk, Jihad; Autorino, Riccardo. - In: MINERVA UROLOGY AND NEPHROLOGY. - ISSN 2724-6442. - (2022). [10.23736/S2724-6051.22.05092-3]
Microwave versus cryoablation and radiofrequency ablation for small renal mass: a multicenter comparative analysis
Del Giudice, Francesco;
2022
Abstract
Background: Ablative techniques emerged as effective alternative to nephron-sparing surgery for treatment of small renal masses. Radiofrequency ablation (RFA) and cryoablation (CRYO) are the two guidelines-recommended techniques. Microwave ablation (MWA) represents a newer technology, less described. Aim of the study was to compare outcomes of MWA to those of CRYO and RFA. Methods: Retrospective investigation of patients who underwent MWA, CRYO, or RFA from seven high-volume US and European centers was performed. The first group included patients who underwent CRYO or RFA; the second MWA. We collected baseline characteristics, clinical, intraoperative and post-operative data. Oncological data included technical success, local recurrence, and progression to metastasis. Multivariate analysis was performed to find predictors for postoperative complications. A composite outcome of "trifecta" was used to assess surgical, functional, and oncological outcomes. Results: 739 patients underwent CRYO or RFA and 50 MWA. CRYO/RFA group had significantly longer operative time (p<.001), but no difference in LOS, post-procedural Hb mean, intra-procedural complications (p=0.180), overall post-procedural complication rates (p=0.126), and in the 30-day re-admission rate (p=0.853) were detected. No predictive parameter of postprocedural complications was found. Concerning functional outcome no differences were detected in terms of eGFR at 1yr (p=0.182), ΔeGFR at 1-yr (p= 0.825) and eGFR at latest follow-up (p=0.070). "Technical success" was achieved in 98.6% of the cases (MWA= 100%, CRYO/RFA= 98.5%; p=0.775), and there was no significant difference in terms of 2-yr recurrence rate (p= 0.114) and metastatic progression (p= 0.203). Trifecta was achieved in 73.0% of CRYO/RFA vs 69.6% of MWA cases (p = 0.719). Conclusions: MWA is a safe and effective treatment option for small renal masses. Compared with CRYO/RFA, it seems to offer low complication rates, shorter operation time, and equivalent surgical and functional outcomes.I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
