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Deivasigamani et al. Mini-invasive Surg 2023;7:9 https://dx.doi.org/10.20517/2574-1225.2022.99 Page 11 of 19

[74]
Atwell et al. noted a relatively comparable overall local recurrence rate (3.2% vs. 2.8%) between RFA and
PCA for renal masses ≤ 3 cm; however, patients in the PCA group had larger and more central tumors with
[43]
a lesser time follow-up interval compared to the RFA patients (1.8 vs. 3.2 years). El Dib et al. showed a
comparable percentage of clinical effectiveness for RFA (90%; 95%CI: 0.86-0.93) and CA (89%; 95%CI: 0.83-
0.94) in a pooled study of published RFA and CA series.

[48]
After controlling for other factors, Kim et al. found that LCA was not a predictor of disease recurrence
compared to PCA. Studies have compared the LRFS, OS, DFS and CSS rates between RPN and CA (LCA
and PCA), respectively. RPN was shown to have better results compared to CA, but the baseline patients’
characteristics and tumor variables such as size and location were not matched. RPN patients had a much
shorter follow-up period compared to the CA group [37,81] .

In a recent meta-analysis, the probability of local tumor progression of published data for LCA was 9.4% in
comparison to 0.4% for the minimally-invasive PN, leading to a projected 9.39-fold greater risk of local
[77]
tumor advancement in patients receiving LCA . Recently, Thompson et al. examined the oncological
[52]
results of cT1a tumors treated with RFA, PN, and PCA. RCC was histologically verified in 41% of the RFA,
58% of PCA and 79% of PN groups, respectively. The projected 3-year RFS were similar among all groups,
with CA group patients being older and having more comorbidities. The MFS in biopsy-confirmed patients
at three years was higher for CA (100%) and PN (99%) than RFA (93%).

In a study by Martin et al. SRMs treated using CA or MWA were compared for local (4.07 vs. 2.53; P =
[82]
0.46), metastatic recurrence (0.8% vs. 0%; P = 0.12), primary effectiveness (93.75 vs. 91.27; P = 0.40), and CSS
(98.27% vs. 96.8%; P = 0.47) which were found to have similar results. The same result was confirmed by
Cobelli et al. , where disease recurrence in patients treated with image-guided percutaneous ablation with
[54]
either MWA or CA was studied and found disease recurrence in 3/47 and 1/30 treated nodules, respectively,
without any statistical significance (98%; P = 0.06). Recurrences are found at 6, 12, and 18 months after CA,
as well as 12 months after MWA.

CA vs. PN
[60]
In a meta-analysis by Deng et al. compared with PN, cryoablation for cT1 renal masses was found to have
poorer oncological outcomes. The OS (HR: 0.52; 95%CI: 0.41 to 0.65; P < 0.001), CSS (HR: 0.43; 95%CI: 0.21
to 0.91; P = 0.03) and RFS (HR: 0.35; 95%CI: 0.25 to 0.50; P < 0.001) rates of PN were significantly lower
compared to the CA group. When evaluating oncological outcomes, the inclusion of elderly patients with a
high comorbidity index profile in the cryoablation group should not be overlooked. This meta-analysis
included studies comparing outcomes in T1b tumors, where CA’s therapeutic application is still being
debated. In a meta-analysis conducted by Uhilig et al. comparing partial nephrectomy versus ablative
[67]
techniques for SRMs, all-cause mortality was higher for CA (IRR = 2.58; 95%CI: 1.92-3.46; P < 0.001),
whereas differences in the cancer-specific mortality were not statistically significant, and CA had a higher
local recurrence rate (IRR = 2.76; 95%CI: 1.5-5.08; P < 0.001). The majority of studies were actually
retrospective, patients’ baseline characteristics such as age, tumor complexity, and location, comorbidities
were not similar, and these findings are not to be taken as conclusive. Whereas in a recent meta-analysis by
Chan et al. in T1a patients, AT was found to have a worse OS rate (HR 1.64; 95%CI: 1.39-1.95) and
[61]
patients are significantly older than PN (MD: 5.70; 95%CI: 3.83-7.58). LRFS with a median five-year follow-
up (HR: 1.54; 95%CI: 0.88-2.71), CSS (HR : 0.68; 95%CI: 0.43-1.08; P = 0.10), MFS (HR: 1.01; 95%CI: 0.35-
RE
2.94; P = 0.98) were similar with PN patients.