Percutaneous thermal ablation for small renal masses
Renal cell carcinoma (RCC) is among the ten most common tumours in men and women. Evolution of imaging modalities, accompanied by extensive screening and imaging surveillance for other diseases, has led to an increased number of small renal tumours being detected incidentally at earlier stages. More than 80% of small renal masses (SRM) are proven to be renal cell carcinoma classified as stage cT1a; ie localised small renal tumours with a maximal diameter smaller than 4cm; and nephron-sparing treatments (NST) are nowadays the accepted standard of care, provided that a healthy kidney segment may be safely preserved. Active surveillance may be an initial management option for patients with significant comorbidities and limited life expectancy, however, partial nephrectomy (PN) is considered the gold standard treatment for SRMs and should be offered to all patients amenable to safe surgical treatment.
Recent guidelines indicate that percutaneous thermal ablation may also be considered a valid alternative treatment option as long as a complete ablation can reliably be achieved. This review gives a brief overview of percutaneous thermal ablation techniques focusing on their main technical aspects and application techniques for curative ablation of small renal cell carcinoma. The authors also provide a critical narrative of the relevant medical literature, with an emphasis on long-term outcomes of comparative effectiveness research, and appraise the percutaneous methods compared to surgery in the context of both long-term oncologic outcomes and of preservation of renal function.
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