title: Safety and Efficacy of Thermal Ablation for Small Renal Masses in Solitary Kidney: Evidence from Meta-Analysis of Comparative Studies.
abstract: OBJECTIVE
  To evaluate comparative renal functional preservation, perioperative and oncologic outcomes, and complications of thermal ablation (TA) versus partial nephrectomy (PN) in management of Small renal masses (SRMs) in solitary kidney.
  
  
  RESULTS
  Medline, Embase, Web of Science and the Cochrane Library were systematically searched. A meta-analysis for comparative studies comparing TA with PN was performed. According to predefined inclusion criteria, seven datasets were identified from 8 observational studies including a total of 628 patients. Cumulated data showed the changes of creatinine (p=0.02) and estimated glomerular filtration rate (eGFR) (p<0.0001) in TA arm were significantly less than these in PN arm. Significantly less new-set chronic kidney disease (CKD) was observed in TA group (p=0.04). In terms of postoperative dialysis rate, the difference favoring TA was also noted, though there is no statistical significance (p=0.09). With regard to perioperative outcomes, our data demonstrated that patients who underwent TA had significantly shorter operation time (p=0.002), less blood loss (p<0.0001), shorter length of stay (p<0.00001), and less transfusion rate (p=0.01) than those underwent PN. In addition, patients underwent TA suffered less intra- and postoperative complications (p=0.007, p<0.00001; respectively). With regard to oncologic outcomes, disease-free survival (DFS) (p<0.00001) and cancer-specific survival (CSS) (p=0.01) in the PN arm were significantly better than these of the TA arm. But, TA yielded a comparable overall survival to PN (p=0.40). Sensitivity analyses led to very similar results with overall results, and confirmed its stability.
  
  
  CONCLUSIONS
  Our analysis indicates that PN have advantage in controlling cancer recurrence. However, TA is associated with significantly better renal functional preservation and perioperative outcomes, and less complications without increasing overall death. Our data suggest that indication for TA may be extended to select younger, healthier patients who desire a much less invasive therapeutic option.
authors.affiliation: Department of Urology, Central Hospital of Zibo, Zibo, China.
authors.forename: Quancheng
authors.initials: Q
authors.lastname: Yang
authors.affiliation: Department of Neurology, Tianjin Nankai Hospital, Tianjin Medical University, Tianjin, China.
authors.forename: Fanzheng
authors.initials: F
authors.lastname: Meng
authors.affiliation: Department of Urology, Tianjin Third Central Hospital, Tianjin, China.
authors.forename: Kai
authors.initials: K
authors.lastname: Li
authors.affiliation: Department of Urology, Central Hospital of Zibo, Zibo, China.
authors.forename: Tong
authors.initials: T
authors.lastname: Wang
authors.affiliation: Department of Urology, Central Hospital of Zibo, Zibo, China.
authors.forename: Qingyuan
authors.initials: Q
authors.lastname: Nie
authors.affiliation: Department of Urology, Central Hospital of Zibo, Zibo, China.
authors.forename: Zi
authors.initials: Z
authors.lastname: Che
authors.affiliation: Department of Urology, Central Hospital of Zibo, Zibo, China.
authors.forename: Min
authors.initials: M
authors.lastname: Liu
authors.affiliation: Department of Pharmacy, Central Hospital of Zibo, Zibo, China.
authors.forename: Yan
authors.initials: Y
authors.lastname: Sun
authors.affiliation: International Medical School, Tianjin Medical University, Tianjin, China.
authors.forename: Lin
authors.initials: L
authors.lastname: Zhao
mesh_terms: D055011:Ablation Techniques / Q000009:adverse effects*; D006801:Humans; D006979:Hyperthermia, Induced / Q000009:adverse effects*; D007668:Kidney / Q000002:abnormalities* / Q000473:pathology*; D007677:Kidney Function Tests; D007680:Kidney Neoplasms / Q000503:physiopathology / Q000601:surgery*; D019990:Perioperative Care; D011183:Postoperative Complications / Q000209:etiology; D017594:Publication Bias; D016896:Treatment Outcome