AUA 2018: Controversies in Urology: Kidney Cancer – Treatment with Thermal Ablation – PRO Rebuttal

San Francisco, CA (UroToday.com) Houston Thompson, MD gave a presentation supporting the role of ablative treatments for small renal masses (SRM). In 2015 a paper from Mayo clinic was published in European Urology comparing patients with clinical stage T1 treated with radiofrequency ablation or cryotherapy and partial nephrectomy.1 This paper received substantial criticism with the main points being:

  1. Short term follow-up of ablation patients. The median follow-up was 2.9 years for the radiofrequency patients and 1.4 years for the cryotherapy patients.
  2. Inconsistent definitions of local recurrence
  3. 27 ablation patients had no follow-up
  4. Clear selection bias
Therefore, the authors from the Mayo Clinic decided to update these data and present a more comprehensive description of these patients with long term follow-up data. This was a study analyzing the experience of the Mayo clinic nephrectomy registry and renal ablation registry. These registries included patients with clinical stage T1AN0M0 renal masses treated during the years 2000-2011. The endpoints of this study included local recurrence free survival, metastasis free survival, and cancer specific survival. Overall 1422 clinical stage T1a patients were included (Table 1). 

Table 1 – Baseline features of Mayo clinic patients:
Baseline Features CT1a
No difference was noted in local recurrence-free survival, metastasis free survival, and cancer-specific survival (Figure 1).

Figure 1: - Local recurrence free survival, metastasis free survival, and cancer specific survival of patients undergoing PN and ablative treatments:
local recurrence free survival


metastases free survival


cancer specific survival

Ablative treatments are far from perfect and could lead to significant complications. These include bleeding with large perinephric hematomas, urine leaks leading to large urinomas, pseudoaneurysms and more.

Despite the disadvantages of ablative techniques, this is still an attractive minimally invasive technique, with good overall results, and relatively low complication rate, and should be utilized more commonly for SRM<3 cm.

Presented by: Houston Thompson, MD, Mayo Clinic, Rochester, MN, USA

References:
1. Thompson Houston et al. Comparison of partial nephrectomy and percutaneous ablation for CT1 renal masses. European Urology 67 (2015) 252-259

Written by:  Hanan Goldberg, MD, Urologic Oncology Fellow (SUO), University of Toronto, Princess Margaret Cancer Centre @GoldbergHanan at the 2018 AUA Annual Meeting - May 18 - 21, 2018 – San Francisco, CA USA


Read the Preceeding Presentation: 
Controversies in Urology: Kidney Cancer – Treatment with Thermal Ablation – PRO 
Read the Opposing Argument:
Controversies in Urology: Kidney Cancer – Treatment with Thermal Ablation – CON
Read the Opposing Argument Rebuttal:
Controversies in Urology: Kidney Cancer – Treatment with Thermal Ablation – CON Rebuttal
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