Comparison of percutaneous and surgical approaches to renal tumor ablation: metaanalysis of effectiveness and complication rates.
OBJECTIVE
To determine the effectiveness and complication rates of ablation of renal cell carcinoma (RCC) performed with a percutaneous approach versus a surgical approach.


METHODS
A search performed on PubMed identified series of renal tumor ablations. Keywords searched included "radiofrequency" (RF), "cryoablation", "cryosurgery", "cryotherapy", "ablation", "renal", "kidney", and "RCC". Review articles were excluded from the search of English-language literature from January 1996 through August 2006. Inclusion criteria were (i) more than one case, (ii) use of RF ablation or cryoablation, (iii) effectiveness based on follow-up imaging, and (iv) report of complication rate. Effectiveness was defined by the proportion of tumors without residual enhancement after one treatment session (ie, primary effectiveness) or after repeated treatments (ie, secondary effectiveness). Major complications were defined as events with substantial morbidity, disability, or increasing level of care. Metaanalysis was performed on primary effectiveness, secondary effectiveness, and major complication rates with a random-effects model. Differences were considered significant if the 95% CIs did not overlap.


RESULTS
Forty-six series (28 percutaneous, 18 surgical) met all inclusion criteria. The primary effectiveness rate for the percutaneous group (87%) was significantly lower than that in the surgical group (94%; P < .05). The secondary effectiveness rate in the percutaneous treatment group (92%) was not significantly different from that in the surgical treatment group (95%; P > .05). The major complication rate in the percutaneous treatment group (3%) was significantly lower than that in the surgical treatment group (7%; P < .05).


CONCLUSIONS
Based on a metaanalysis, when ablating renal tumors, a percutaneous approach was safer than an open or laparoscopic approach and was equally effective. However, more than one procedure was needed to treat the tumor completely.
Hui
Gladwin C
GC
Division of Abdominal Imaging and Intervention, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA. gladwin.hui@utoronto.ca
Tuncali
Kemal
K
Tatli
Servet
S
Morrison
Paul R
PR
Silverman
Stuart G
SG
D017115:Catheter Ablation / Q000706:statistics & numerical data*; D003452:Cryosurgery / Q000706:statistics & numerical data*; D006801:Humans; D015994:Incidence; D007680:Kidney Neoplasms / Q000453:epidemiology* / Q000601:surgery*; D011183:Postoperative Complications / Q000453:epidemiology*; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors; D016896:Treatment Outcome