title: Management and outcomes of tumor recurrence after focal ablation renal therapy.
abstract: OBJECTIVE
  Cryoablation (CA) and radiofrequency ablation (RFA) have emerged as viable treatment options for patients with small renal masses. Although the intermediate oncologic outcomes are comparable to those of surgery, the management of a recurrence is still controversial. This review intends to provide a comprehensive overview of management options and outcomes after failed focal ablation renal therapy. In addition, it presents how patients in whom CA and RFA fail are treated at our institution.
  
  
  METHODS
  A systematic review of the Pub-Med database was performed to identify articles on renal CA and RFA. The keywords used were "small renal mass," "enhancing renal mass," "cryoablation," "radiofrequency ablation," "tumor recurrence," "postablation," "management," "salvage nephrectomy," "partial nephrectomy," "laparoscopy," and "active surveillance." English-language articles between 1995 and 2009 were reviewed.
  
  
  RESULTS
  A total of 30 articles were included in this review; however, only 6 original articles were found that dealt specifically with the theme of this review. In the case of tumor recurrence after failed CA or RFA, viable management options include active surveillance, repeated ablation, and salvage partial/radical nephrectomy. Active surveillance up to 1 year appears to be a safe option in patients with early enhancement after CA or RFA, because the majority of the enhancements may be from postoperative inflammation. Repeated CA and RFA remain the most commonly performed procedures after a failed ablation with excellent oncologic outcomes. When significant tumor progression is present on postoperative follow-up, however, surgery is necessary. Although a partial nephrectomy would be advisable to preserve renal function, intraoperative and postoperative complications are a concern because of scarring and fibrosis from the initial ablation. For this reason, a radical nephrectomy is most commonly preferred. This could be performed through an open or a laparoscopic approach.
  
  
  CONCLUSIONS
  When a recurrence is suspected after CA or RFA, different options are available. This review has highlighted that active surveillance, reablation, and surgery (usually radical nephrectomy) are all viable options for the management of a failed ablative procedure.
authors.affiliation: Institute of Urologic Oncology, Department of Urology, David Geffen School of Medicine at the University of California, Los Angeles, Los Angeles, California 90095, USA.
authors.forename: Alberto
authors.initials: A
authors.lastname: Breda
authors.forename: Christine
authors.initials: C
authors.lastname: Anterasian
authors.forename: Arie
authors.initials: A
authors.lastname: Belldegrun
mesh_terms: D017115:Catheter Ablation; D003452:Cryosurgery; D006801:Humans; D007668:Kidney / Q000473:pathology* / Q000601:surgery; D007680:Kidney Neoplasms / Q000473:pathology / Q000601:surgery*; D009364:Neoplasm Recurrence, Local / Q000175:diagnosis / Q000601:surgery*; D009392:Nephrectomy; D012086:Reoperation; D017211:Treatment Failure