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Renal Cell Cancer: Percutaneous or Surgical Approach for Ablation Therapy?

August 5, 2009
Written by: , Filed in: Interventional Radiology
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Renal cell cancer (RCC) is becoming increasingly more common in the United States. Classically, the treatment of RCC was nephrectomy, but ablative therapy is becoming more common.

Until this recent study, there has never been a large-scale meta-analysis conducted to evaluate the effectiveness and complication rates of ablations performed via a surgical versus a percutaneous approach.

Objective
To conduct a comprehensive meta-analysis of the literature to identify clinical series of renal ablations performed by any method between 1996 and 2006.

Methodology
46 cases were evaluated for complications and effectiveness. Results were separated into 28 series for the percutaneous approach and 18 for the surgical approach. The follow-up was 15.9 months.

A total of 665 tumors in 578 patients were treated percutaneously, and 515 tumors in 477 patients were treated with a surgical approach.

Interventional Radiology Review
 University of California San Francisco Department of Radiology
  Interventional Radiology Review is an excellent program to view a wide variety of unknown cases. Topics covered include Vascular Interventions and Non Vascular interventions such as:
 
 • Evaluation of Vascular Trauma
 • Arterial and Venous Catheter Angiography
 • Magnetic Resonance Angiography
 • Cholangiography
 • Chest Interventions
 • Nephrostomy and Ureteral Stents
 
  Earn up to 26 AMA PRA Category 1 Credits™.  
  Click here to read more or order: Interventional Radiology Review

Results
There were some statistically significant differences noted. More tumors were biopsied prior to ablation in the surgical group versus the percutaneous group (88% vs 57%).

Of the biopsied cases, the surgical group had a significantly lower incidence of RCC (64%) compared with the percutaneous group (84%).

Tumors in the percutaneously treated group were bigger (mean, 2.8 cm) than in the surgical group (mean, 2.5 cm).

Major complications were significantly less common after the percutaneous approach than the surgical approach (3.1% vs 7.4%).

The length of stay was longer for the surgical approach versus the percutaneous approach (3.0 days vs 1.4 days. The primary effectiveness of the percutaneous approach was significantly lower at 87% vs 94% for the surgical approach.

The secondary effectiveness rates were not significantly different at 92% for the percutaneous approach and 95% for the surgical approach.

Reviewer’s Comments
This meta-analysis was done to determine the effectiveness and safety of these 2 approaches to RCC ablation to determine which is the best method to use.

The surgical approach seems to have a higher primary effectiveness rate, but the effectiveness is the same once another procedure is done percutaneously.

The type of ablation technique, modality, and anesthesia used may have also influenced effectiveness rates.

Limitations of this meta-analysis include a short follow-up (15 months as the mean for the surgical approach).

These findings do confirm the assumption that the percutaneous approach causes significantly fewer major complications and significantly shorter hospital stays.

According to the authors of the study, this is more impressive given the fact that patients undergoing percutaneous approaches are more likely to be more ill, with more comorbidities. Therefore, percutaneous approaches can lead to greater cost-effectiveness and shorter hospital stays for patients.

To summarize, ablation of RCC done via a percutaneous approach has a lower incidence of major complications and a shorter length of stay, while surgical RCC ablation has a higher primary effectiveness rate.

Author: Sharon Gonzales, MD

References:
Hui GC, Tuncali K, et al. Comparison of percutaneous and surgical approaches to renal tumor ablation: metaanalysis of effectiveness and complication rates. J Vasc Interv Radiol; 2008; 19 (September): 1311-1320

Interventional Radiology Review
 University of California San Francisco Department of Radiology
  Interventional Radiology Review is an excellent program to view a wide variety of unknown cases. Topics covered include Vascular Interventions and Non Vascular interventions such as:
 
 • Evaluation of Vascular Trauma
 • Arterial and Venous Catheter Angiography
 • Magnetic Resonance Angiography
 • Cholangiography
 • Chest Interventions
 • Nephrostomy and Ureteral Stents
 
  Earn up to 26 AMA PRA Category 1 Credits™.  
  Click here to read more or order: Interventional Radiology Review
.

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