title: Differences in patterns of care: reablation and nephrectomy rates after needle ablative therapy for renal masses stratified by medical specialty.
abstract: OBJECTIVE
  We aimed to study differences in reablation rates, modality utilization, and outcomes after renal tumor cryoablation (CA) and radiofrequency ablation (RFA), stratified by medical specialty.
  
  
  METHODS
  A literature review was performed to identify papers reporting renal RFA and CA results. Patient demographics and clinical and pathological variables were collected, as were ablation success and salvage treatment rates.
  
  
  RESULTS
  Interventional radiologists (IR) reported more experience with renal RFA than with CA (31.4% v 11.3% of all reported cases, p < 0.001). However, the majority of renal RFA and CA are performed by urologists. The percutaneous approach was used far more often with RFA than with CA, reflecting this preference by radiologists (80.9% v 23.4%, p < 0.01). The mean tumor size, cancer-specific survival rates, mean follow-up duration, and salvage nephrectomy rates were not statistically different between CA and RFA. Tumor reablation rates were significantly higher for RFA than for CA (7.4% v 0.9%, p = 0.009). RFA reablation rate correlated closely to surgeon specialty, such that 72% of reablations were reported by IR, while only 28% were performed primarily by urologists (p < 0.0001). This was despite IR being primary surgeons in only 31.4% of first tumor ablations. Salvage nephrectomy was performed more after CA than after renal RFA, probably because 89% of CA were done by urologists. There were no reablations in the laparoscopically approached cases.
  
  
  CONCLUSIONS
  Cancer-specific outcomes after renal tumor CA and RFA are similar. However, RFA has required more reablations to achieve 95% cancer-specific survival rates. IR reported more experience with RFA, and urologists reported more experience with CA. Overall, RFA and CA reablation rates are significantly higher when a percutaneous approach is used and seemed to correlate with surgeon specialty.
authors.affiliation: Department of Urology, University of Washington, Seattle, Washington 98195, USA. longl@u.washington.edu
authors.forename: Layron
authors.initials: L
authors.lastname: Long
authors.forename: Sangtae
authors.initials: S
authors.lastname: Park
mesh_terms: D017115:Catheter Ablation / Q000379:methods*; D003452:Cryosurgery / Q000379:methods*; D003695:Delivery of Health Care / Q000706:statistics & numerical data*; D003710:Demography; D006801:Humans; D007680:Kidney Neoplasms / Q000601:surgery*; D008511:Medicine; D009392:Nephrectomy / Q000379:methods*; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data; D013038:Specialization