Platinum Priority – Kidney CancerEditorial by Firas G. Petros and Surena F. Matin on pp. 118–119 of this issueCryoablation versus Partial Nephrectomy for Clinical T1b Renal Tumors: A Matched Group Comparative Analysis
Introduction
Over the last decade there has been a sharp increase in the detection of incidental renal tumors attributed to the ubiquitous use of abdominal imaging in current medical practice. As the incidental detection of renal masses has increased, so has our knowledge of the natural history of the disease. This knowledge has led to adoption of nephron-sparing techniques such as partial nephrectomy (PN) and focal ablative therapy options for the treatment of renal cell carcinoma (RCC). The treatment algorithm for cT1b renal tumors is still evolving and the treatment options available to practitioners are expanding. The traditional treatment for a cT1b renal tumor has been radical nephrectomy. However, guidelines have recently shifted towards PN, and state that if a cT1b renal tumor is amenable to PN, it is the treatment of choice in select patients [1], [2]. Furthermore, since the introduction of renal cryoablation (CA) in the late 1990s, practitioners have extended the role of CA to treat cT1b tumors in select patients. A recent study reported similar oncologic outcomes for cT1b renal masses treated by PN and CA [3]. The use of CA as a possible oncologically equivalent treatment option for the management of cT1b renal masses must be considered with utmost care and should not be considered oncologically equivalent to PN until further studies are performed. Our objective was to evaluate the efficacy of CA compared to PN for cT1b tumors with respect to oncologic survival outcomes.
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Data acquisition
We reviewed our prospectively maintained CA and PN databases approved by the institutional review board. Patients included for analysis underwent either renal CA (laparoscopic or percutaneous) or PN (robot-assisted approach) for a cT1b renal mass (>4 cm and ≤7 cm and no imaging concerns regarding more advanced disease) between November 1999 and August 2014.
Our technique for CA (both laparoscopic and percutaneous) and robotic PN have previously been described [4], [5], [6]. Of note, the technique
Results
A total of 31 patients were treated using CA and 161 patients were treated using PN during the study period. Key baseline patient and tumor characteristics are listed in Table 1. The CA group consisted of patients who were treated with both laparoscopic (n = 25, 81%) and percutaneous (n = 6, 19%) approaches. All key variables except BMI and gender were significantly different at baseline between the two groups.
After 1:1 matching, the balance of the key variables was checked, and the results show
Discussion
The treatment algorithm for cT1b renal tumors has changed over the last few decades to favor the nephron-sparing PN approach, reserving the traditional treatment of radical nephrectomy for complex tumors not amenable to PN [1], [2]. To follow this trend of nephron-sparing approaches, practitioners have extended the role of CA to treat cT1b tumors in selected patients. Thompson et al [3] reported similar oncologic outcomes for PN and CA of cT1b renal masses, with 3-yr local recurrence–free
Conclusions
Patients treated with CA for cT1b renal tumors had a higher rate of local cancer recurrence than patients treated with PN. Until further studies are performed to clearly define the role of CA in cT1b renal tumors, CA should be reserved for patients with imperative indications for nephron-sparing surgery who cannot be subjected to the risks of more invasive PN.
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