The Role of Ablation and Minimally Invasive Techniques in the Management of Small Renal Masses

Context: Nephron-sparing approaches are increasingly recommended for incidental small renal masses. Herein, we review the current literature regarding the safety and efficacy of focal therapy, including percutaneous ablation, for small renal masses. Objective: To summarize the application of ablative therapy in the management of small renal masses. Evidence acquisition: PubMed and Medline database search was performed to look for findings published since 2000 on focal therapy for small renal masses. After literature review, 64 articles were selected and discussed. Evidence synthesis: Radiofrequency ablation and cryotherapy are the most widely used procedures with intermediate-term oncological outcome comparable with surgical series. Cost effectiveness seems excellent and side effects appear acceptable. To date, no randomized trial comparing percutaneous focal therapy with standard surgical approach or active surveillance has been performed. Focal ablative therapies are now accepted as effective treatment for small renal tumors. Conclusions: Focal ablative therapies are now accepted as effective treatment for small renal tumors. For tumors <3 cm, oncological effectiveness of ablative therapies is comparable with that of partial nephrectomy. Percutaneous ablation has fewer complications and a better postoperative profile when compared with minimally invasive partial nephrectomy. Patient summary: Focal ablative therapies are now accepted as effective treatment for small renal tumors. For tumors <3 cm, oncological effectiveness of ablative therapies is comparable with that of partial nephrectomy. (C) 2018 European Association of Urology. Published by Elsevier B.V. All rights reserved.