Authors' recommendations: Kunkle et al (2008b) assessed oncological outcomes of RFA compared to cryoablation in 47 case series for 1375 renal tumours. Each ablative technique is presented regardless of approach; that is, open, laparoscopic and percutaneous approaches are reported together. Mean follow-up was 15.8 months for RFA compared to 22.5 months for cryoablation (range or confidence intervals not provided). Overall rates for key outcomes are presented. RFA (12.9%; 100/775 lesions) has significantly higher rates of tumour progression than cryoablation (5.2%; 31/600 lesions), P<0.0001. Reablation rates are also significantly higher following RFA were reported as (8.5%; 66/775) compared with cryoablation (1.3%; 8/600), P<0.0001. The rates of progression to metastatic disease were similar between RFA (2.5%; 19/775 lesions) and cryoablation (1%; 6/600 lesions), P=0.06. Univariate and multivariate models analysing local tumour progression and metastatic disease were conducted. Forty-three (91%) of studies reported complete data and were included in the regression analyses. The incidence of local tumour progression correlated significantly with ablation modality in the univariate (P=0.001) and multivariate (P=0.003) regression analyses. The incidence of malignant pathology was marginally associated with duration of follow-up (P=0.076). No other variables were associated with local tumour progression.Overall, this study shows the incidence of local tumour progression is significantly lower in cryoablation compared with RFA but that no statistical differences were detected in the incidence of progression to metastatic disease. The authors conclude that ablative technologies are viable strategies for small renal masses based on short-term outcomes but that long-term outcomes are lacking.Long and Park’s (2009) review assessed reablation rates for RFA and cryoablation stratified in terms of the surgical approach (i.e., open, laparoscopic or percutaneous) for 24 studies (n = 620; this figure was used interchangeably between patient numbers and renal masses). The number of patients for each RFA approach were as follows: open (0), laparoscopic (54/283; 19%), and percutaneous (229/283; 80%); and for cryoablation: open (22/337; 6.5%), laparoscopic (236/337; 76%), and percutaneous (59/337; 18%). Overall reablation rates for RFA were reported as 7.4% vs. 0.9% for cryoablation (P<0.05) to achieve 95% success. Reablation rates for the open approach could not be compared between groups since no patients underwent primary RFA. Reablation rates for the laparoscopic group were reported as RFA (0%) and cryoablation (0%); P=ns; and for the percutaneous group were reported as RFA (8.8%) vs. cryoablation; (2.5%) P<0.05. The incidence of salvage nephrectomy was reported as cryoablation (2.4%) vs. RFA (1.1%). Interventional radiologists reported more experience with renal RFA than with cryoablation, whilst urologists were reported to use cryoablation more frequently than RFA. Mean follow-up was 20 months for both RFA (range 7 to 55 months) and cryoablation (range 6 to 25 months).These authors concluded that that reablation after RFA is more common than cryoablation and that an increased number of RFA reablations is required to achieve 95% cancer-specific success rates. However, they suggest that further research is needed to inform on the comparative effectiveness of each modality. With regard to surgical approach, reablation rates were shown to be significantly higher for the percutaneous approach.

Project Status: Completed

URL for project: http://www.surgeons.org/media/17426/RPT_2010-03-04_Evidence_Essential_RFA_for_renal.pdf

Year Published: 2010

English language abstract: An English language summary is available

Publication Type: Not Assigned

Country: Australia

Organisation Name: Australian Safety and Efficacy Register of New Interventional Procedures-Surgical

Contact Address: ASERNIP-S 24 King William Street, Kent Town SA 5067 Australia Tel: +61 8 8219 0900

Contact Name: racs.asernip@surgeons.org

Contact Email: racs.asernip@surgeons.org

Copyright: Australian Safety and Efficacy Register of New Interventional Procedures - Surgical (ASERNIP-S)