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Page 10 of 19 Deivasigamani et al. Mini-invasive Surg 2023;7:9 https://dx.doi.org/10.20517/2574-1225.2022.99

Investigations of the risk factors correlating to local recurrence rate following CA have found that increased
SRM size and endophytic growth are the factors most predictive of local tumor recurrence [69,70] , which
parallels the finding that SRM size and central tumor location are the factors most predictive of procedural
complication [46,51,58] .

PCA
[71]
Schmit et al. reported a 3.5% treatment failure rate, with 63% of tumors being RCC with a mean follow-up
of 27.9 months. Breen et al. reported a 7.6% primary treatment failure rate, which was reduced to 2.4%
[46]
[72]
after PCA retreatment. Stacul et al. reported 97.8% of treatment success rates in 338 SRM patients who
underwent cryoablation, 47% of whom had histologically confirmed RCC with a mean tumor size of 2.53
cm and were followed up for 5 years. Recurrence-free survival rates were 90.5% at 3 years and 82.4% at 5
years in a subset of 159 patients with biopsy-proven RCC. Overall survival (OS) rates were 96.0% at 3 years
and 91.0% at 5 years, with no patient developing the metastatic disease in this subset. Although there were
studies reporting oncological outcomes following PCA in small renal masses, most of them assessed cancer-
specific outcomes in all individuals either with a validated diagnosis of benign illness or without a clear RCC
diagnosis which is challenging to be included in this review [73,74] .

LCA
[75]
Aron et al. studied the five-year OS of 80 patients with biopsy-proven RCC and reported it to be 84% at a
median follow-up of 93 months, as well as cancer-specific survival and recurrence-free survival of 92% and
[37]
81%, respectively. Guilloteau et al. found an 11% recurrence rate in 181 out of 234 masses [77% biopsy-
proven RCC] with a median follow-up of 44.5 months. Tsivian et al. reported a 4.3% local recurrence rate
[69]
at a median follow-up of 20 months for a group of 163 patients receiving LCA, 118 of whom had “biopsy-
proven RCC”. Importantly, the authors identified t tumor size and endophytic growth pattern as indicators
of post-treatment tumor recurrence.

Metastasis-free survival (MFS) rates and local recurrence-free survival (LRFS) were studied in 220 patients
with biopsy-proven RCC at three-year and five-year outcomes, with an estimated 97.7% and 97.2% at three
years and 94.4% and 93.9% at 5 years. At three and five years, the estimated OS for all 433 patients was
91.7% (95%CI: 87.5%; 94.5%) and 78.8% (95%CI: 71.1%; 84.6%), respectively . This is significantly lesser
[76]
than the reported LRFS rate for partial nephrectomy, but no significant difference was noted in cancer-
specific survival and LRFS rates, which were comparable with recent studies by Thompson et al. and
[77]
Georgiades and Rodriguez .
[78]
Nielsen et al. investigated the five- and ten-year survival results in individuals with biopsy-proven RCC
[79]
after cryoablation. The study comprised 179 individuals (116 males and 63 women) with an average age of
64 years and a mean tumor size of 27mm. The predicted Disease-free survival rate (DFS) after five years was
79%. The 5- and 10-year OS rates were 82% and 61%, respectively. The same study reported a 5-year and 10-
year disease-free survival rate of 90.4% and 80%, and OS rate of 83.2% and 64.4%, respectively, in a multi-
institutional trial of patients who underwent LCA that was comparable to the recurrence and metastasis-free
survival following extirpative surgery for RCC [55,79,80] .

CA vs. other ablative techniques
Oncologic results with various CA procedures have been documented in comparative series, as well as
comparisons of CA with PN and RFA. Owing to inherent biases in patient and tumor selection, variations
in rates of malignancies, disparities in the success criteria, and differences in follow-up timeframes, any
objective comparative analysis of provided treatment methods is limited.