Partial nephrectomy versus ablative therapies for cT1a renal masses: A Systematic Review and meta-analysis

Objectives: ablative techniques have been increasing as an alternative to surgical approaches, especially in patients who are unfit for surgery. This study was performed to compare oncologic and functional outcomes after partial nephrectomy (PN) and ablation for treating clinical T1a renal masses. Methods: An electronic search was completed on the basis of PubMed, Embase and Cochrane Central Register of Controlled Trials. Studies comparing partial nephrectomy versus ablative therapies in patients with small renal masses were enrolled. Results: Twenty articles incorporating 5,011 patients were eligible for the present meta-analysis. Perioperative complications were fewer in the ablation group than in the PN group (OR = 0.76; 95%CI, 0.60 -0.97; P = 0.025), but ablation group was associated with increased risk of local recurrence (OR = 1.88; 95%CI, 1.29-2.72; P = 0.001) and lower OS (HR =1.53; 95% CI, 1.16-2.00; P = 0.002). CSS and DFS were comparable in two groups. Decline of renal function at 6-month follow up was lower in ablation than PN (WMD = 3.32; 95% CI, 0.04-6.60; P = 0.047). Beside, ablation had a trend towards lower reduction of renal function of long-term follow up (WMD = 3.06; 95% CI, -2.13-8.25; P = 0.247). Conclusion: Compared to PN, ablation may have a significantly lower OS and higher local recurrence rates in selected patients, while CSS and DFS were comparable between the two treatments. On the other hand, ablation had a significantly decreased risk of perioperative complication and the potential advantage of long-term renal function preservation. More large randomized controlled trials are needed further to enhance the evidence of ablation in patients with small renal tumors. We believe that ablation is an attractive addition to the urologist's treatment options for small renal masses. (C) 2019 Published by Elsevier Ltd.