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Page 2 of 3 Celia et al. Mini-invasive Surg 2020;4:5 I http://dx.doi.org/10.20517/2574-1225.2018.007

patients. The advantages of a nephron-sparing approach are clearly related to renal function preservation
guaranteeing consistent oncological outcomes.

Although radical surgical procedures remain the definitive recommended treatment of SRM, non-surgical
management or ablative techniques have emerged recently, particularly for smaller tumours (< 4 cm) and
for those patients who are not eligible for surgery. Although the overall oncological outcomes are still
under evaluation, ablative techniques could theoretically offer the benefit of nephron-sparing treatment
with the clear advantages of minimally invasive approaches.

Ablative techniques include cryoablation, radiofrequency ablation, microwave ablation, laser thermal
ablation and high-intensity focused ultrasound. Evidence from the literature is more extensive
for cryoablation and radiofrequency ablation while the other modalities are still to be considered
[3]
experimental .
To date, appropriate selection of the best therapeutic option needs to be determined on a case by case basis
with thorough patient counseling. There is always a need to find the right balance between the benefits of a
given treatment and its risks, without forgetting patients’ characteristics.

In this context, ablative modalities seem to be a potentially valid treatment option that can reduce the
morbidity and complications related with surgical procedures with acceptable oncologic and functional
outcomes.

However, considering the literature, only few series are reporting intermediate - long term survival data
and several studies are still evaluating the oncologic efficacy of ablative modalities.

The overall low evidence found in the literature and the lack of standardized techniques are still to be
considered as major limitations for these non surgical approaches. Multicentric, randomized high volume
trials are typically very complicated to perform in these settings. However, higher quality data from larger
series coming from expert centres, focusing on standardization and safety are eagerly awaited for in order
to obtain better and comparable oncological outcomes and to allow better reproducibility and teaching of
the techniques.

The aim of this review is to focus on the best evidence available on the overall management of SRM
highlighting the process from the diagnosis to the non surgical treatment modalities.

DECLARATIONS
Authors’ contributions
Wrote and reviewed the manuscript: Celia A, Naspro R

Availability of data and materials
Not applicable.

Financial support and sponsorship
None.

Conflicts of interest
Both authors declared that there are no conflicts of interest.