Because they have not been directly compared in prospective clinical trials, it can be difficult to offer one more than the other. Nevertheless, thermal ablation is not very popular with clinicians. Indeed, even if clinical studies consider ablative therapy more attractive than active surveillance, this last option is often favored in our daily practice. In this context, we performed indirect analysis of thermal ablation and active surveillance, comparing each of these approaches to the partial nephrectomy, which is still considered the gold standard.
We would like to highlight some limitations including the lack of randomized controlled studies and the limited number of prospective evaluations. However, we decided to consider all articles relevant to the discussion topic. Few published studies compare the oncological outcomes of partial nephrectomy or focal therapy with those of active surveillance. The lack of data did not allow us to perform a subgroup analysis of laparoscopic vs percutaneous thermal ablation, or radiofrequency ablation vs cryoablation. However, studies including original data suggest that the surgical approach or type of energy should not make any difference. Network analysis itself has limited evidence due to indirect comparison. Studies directly comparing partial nephrectomy, thermal ablation, and active surveillance are missing. However, the low statistical heterogeneity in our evaluations allows us to assume that these findings are reliable.
We believe that our findings about thermal ablation prevalence in oncological outcomes may affect the management of patients with small renal masses.
Written by: Dmitry Enikeev1,2,3 Andrey Morozov3 & Eric Barret4
- Karl Landsteiner Institute of Urology and Andrology, Vienna, Austria
- Department of Urology, Medical University of Vienna, Vienna, Austria
- Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia
- Department of Urology, Institut Mutualiste Montsouris, Paris, France
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