Renal Function With Ablative Techniques for Renal Mass in Solitary Kidney
For patients with a renal mass in a solitary kidney, partial nephrectomy and percutaneous cryoablation appear to be associated with comparable renal functional outcomes, based on the findings of a retrospective review of institutional databases. Jay D. Raman, MD, of the Penn State Milton S. Hershey Medical Center, and colleagues suggest that ablative techniques may be “a particularly attractive option for managing tumors in solitary renal units at risk of declining function.” These study findings were published in BJU International.
In this review, 89 patients with 98 renal tumors in a solitary kidney were treated with radiofrequency ablation or open partial nephrectomy under cold ischemia. Patient and surgeon preference, tumor characteristics, and comorbidities guided the choice of therapy.
The outcomes of the 47 patients treated with ablation and the 42 patients treated with nephrectomy were assessed, at a median follow-up of 18.1 and 30.0 months, respectively. The investigators found a greater decline in glomerular filtration rate (GFR) at all times evaluated in patients treated with nephrectomy compared with ablation (soon after the procedure: 15.8% vs. 7.1%), 12 months after surgery (24.5% vs. 10.4%), and at last follow-up (28.6% vs. 11.4%). In addition, in those with a pretreatment GFR of > 60 or > 30 mL/min/1.73 m2, a new onset of decline in GFR of < 60 and < 30 mL/min/1.73 m2 was reported in 0% and 7% of patients after ablation and in 35% and 17% of patients after nephrectomy, respectively.