Radiofrequency Ablation, Cryoablation, and Microwave Ablation for the Treatment of Small Renal Masses: Efficacy and Complications

Round 1

Reviewer 1 Report

Review Report

·      In this article, the authors aimed to compare different ablative modalities of RCC, in terms of effectiveness, efficacy, complication and oncological outcomes

·      The review is very interesting, written in a good fluent language, well-structured, and correctly organized. The authors have worked hard to present their opinion in a good manner.

·      Although the topic is not novel, the article provides a comprehensive review of the different ablative modalities of RCC.

·      I think it will contribute to the current literature.

·      I have a few recommendations:

1.      Add figures.

2.      Tabulate some of your data.

Author Response

Dear Reviewer,
the response to the comment is in the attached file. 

Thank you very much

Author Response File: Author Response.docx

Reviewer 2 Report

In the abstract: it is mentioned that ablation, should be offered to patients with comorbidities. This isn’t completely true nowadays.

Introduction:

What about the guidelines/recommendations of the EAU (admittedly indeed referred to in the ‘current guidelines’ section) ?

Why not performing lesional biopsy in all patients ? How can the ‘oncological outcome of ablation’ can be seriously interpreted when the histology of the treated lesion is unknown. Indeed, many small renal lesions are benign … Lipid-poor angiomyolipoma, oncocytoma; in addition differences in papillary RCC and the classical clear cell RCC …

Patient selection:

Is the lesional growth over time a reliable feature for decision of treatment ?

Study of the lesion:

Is ‘fusion’ of PET-CT images with CT (or US)  during ablation feasible ?

Ablation technique:

RFA: is a needle with retrievable hook-umbrella preferable ?

Anesthesia ?

Outcomes:

See above comment in the introductory section.

Complication rates:

Does perprocedural lesional biopsy interfere with the complication rate ?

Radiologists’ awareness of imaging features after ablation … imaging can be rather tricky.

Author Response

Dear Reviewer,
the response to the comment is in the attached file. 

Thank you very much

Author Response File: Author Response.docx