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COMPARISON OF PERCUTANEOUS MICROWAVE ABLATION GUIDED BY COMPUTER TOMOGRAPHY AND PARTIAL NEPHRECTOMY IN THE TREATMENT OF T1A STAGE OF RENAL CANCER
LUKA NOVOSEL
orcid.org/0000-0001-7515-9110
; Medical Faculty, University of Zagreb, Zagreb, Croatia
LADA LIJOVIĆ
; Department for Diagnostic and Interventional Radiology, Clinical Hospital Center Sestre milosrdnice, Zagreb, Croatia
VINKO VIDJAK
; Department of Anesthesiology, Intensive Medicine and Pain Treatment, University Hospital Merkur, Zagreb, Croatia
Abstract
Purpose: Better availability of radiologic imaging leads to an increase in the incidence of small renal cell carcinoma (RCC), which in turn gives rise to the need for developing minimally invasive and nephron sparing therapy. Along with partial nephrectomy (PN), as the gold standard therapy, percutaneous ablative methods have been introduced in patients with severe comorbidities. Despite its advantages when compared to other ablative methods, microwave ablation (MWA) has not been introduced into therapy guidelines and is still considered to be an experimental method. The aim of the study was to compare local recurrence rates, overall survival, metastasis-free survival and cancer specifi c survival after percutaneous computer tomography (CT) guided MWA and PN in the therapy of T1a stage of RCC. Methods: The retrospective study involved 80 patients, who were diagnosed and histologically confi rmed with T1a stage RCC from January 2015 to June 2018. All patients were candidates for MWA or open PN, depending on the decision of the multidisciplinary team at the University Hospital Center Sestre milosrdnice. Surgical patients were chosen, according to their tumour size and complexity, to match the patients treated with MWA in size and complexity of the tumour using propensity score matching. All included patients were under radiological and clinical follow-up for a period of at least 12 months. MWA procedures were performed via percutaneous approach under CT guidance. Results: Oncological outcomes did not show any statistically signifi cant difference between MWA and PN. Overall survival was 100% after one year in both groups. One-year recurrence-free survival was 92,5% after MWA and 90% after PN, with 3 patients showing evidence of local recurrence after MWA and 5 patients after PN. All patients with local recurrence were retreated with MWA after 2-4 weeks with a secondary-effi cacy of MWA being 100%. Despite a higher number of patients showing local recurrence or metastasis in the PN group, there was no signifi cant difference found in our study. Metastasis-free survival was 97,5% after MWA and 95% after PN. Even though average glomerular fi ltration rates were not signifi cantly different between the MWA and PN group before and after the procedure, the percentage decrease in the glomerular fi ltration rate was signifi cantly lower after MWA, -8.9 ± 6 % vs -21.7 ± 8.2 % (P<0,001). The ablation group was associated with signifi cantly lower estimated blood loss (54,0 ± 19,0 mL vs 225,1 ± 45,7 mL, P<0,001). Conclusion: It can be concluded that percutaneous MWA can be used as an equally successful therapeutic tool in small RCC, when compared to the golden standard of PN, in patients with severe comorbidities, but also in other patients due to its nephron sparing qualities.
Keywords
kidney cancer; nephrectomy; microwave ablation; computorized tomography; interventional radiology
Hrčak ID:
307178
URI
Publication date:
10.8.2023.
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