Thermal ablation for local tumor recurrence after previous partial nephrectomy: Perioperative and oncological outcomes

Surgery is considered the standard of care for patients with localised renal cell carcinoma (RCC), according to European Association of Urology (EAU) guidelines [1]. Herein, partial nephrectomy (PN) represents the first-choice treatment for patients with cT1a-b tumors and could be also considered in patients with T2 tumors and a solitary kidney or chronic kidney disease, when technically feasible. Several previous analyses demonstrated that PN provides similar oncological outcomes, with a better preservation of general renal function, when compared to radical nephrectomy (RN) [[1], [2], [3]].

However, multiple surgical series reported a local recurrence rate ranging from 1.4% to 10% after PN [[4], [5], [6]]. The management of local tumor relapses at the site of the primary surgical resection still represents a challenging situation. In this scenario, salvage surgery has been described as a valid option [7]. However, it may hide technical difficulties due to unfavorable location of the relapse, perilesional fibrosis, and it may be discouraged by patient's characteristics, namely advanced age and comorbidities [[7], [8], [9]].

Image‐guided percutaneous thermal ablation (PTA) has been suggested as a valid treatment for the management of small renal masses (SRMs) [1,10]. Recently, PTA has been also proposed as an intriguing alternative for the treatment of tumor relapses on surgical site after previous PN [7,8]. However, the potential role of PTA as treatment modality for tumor recurrences was only investigated in six previous case-series [9,[11], [12], [13], [14], [15]]. This said, until today, the oncological safety of PTA as a valid alternative to surgery for treatment of local recurrences after previous PN has not been yet established.

The present study aims to report perioperative, functional and oncological outcomes of, to the best of our knowledge, the largest single center series of patients treated with PTA, namely radiofrequency (RF) or microwave ablation (MW), for local recurrence on the site of the primary surgical resection after PN.

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