Next Article in Journal
Assessment of the Mechanisms of Action of Eribulin in Patients with Advanced Liposarcoma Through the Evaluation of Radiological, Functional, and Tissue Responses: A Prospective Monocentric Study (Malibu Study)
Previous Article in Journal
Advancements in Assessing Pathological Fracture Risk: News on Mirels’ Score
Previous Article in Special Issue
Robotic Surgery in the Management of Renal Tumors During Pregnancy: A Narrative Review
 
 
Search for Articles:
Title / Keyword
Author / Affiliation / Email
Journal
Article Type
 
 
Advanced Search
 
Section
Special Issue
Volume
Issue
Number
Page
 
Journals
Cancers
Volume 17
Issue 6
10.3390/cancers17060974
cancers-logo
Submit to this Journal Review for this Journal Propose a Special Issue
► Article Menu

Article Menu

share Share announcement Help format_quote Cite question_answer Discuss in SciProfiles
first_page
settings
Order Article Reprints
Font Type:
Arial Georgia Verdana
Font Size:
Aa Aa Aa
Line Spacing:
Column Width:
Background:
Systematic Review

Minimally Invasive Salvage Approaches for Management of Recurrence After Primary Renal Mass Ablation

by
Mohammadreza Askarpour
1 and
Alireza Aminsharifi
2,*
1
Department of Urology, University of Pittsburgh School of Medicine, Pittsburgh, PA 15232, USA
2
Department of Urology, Hershey Medical Center, PennState College of Medicine, Hershey, PA 17033, USA
*
Author to whom correspondence should be addressed.
Cancers 2025, 17(6), 974; https://doi.org/10.3390/cancers17060974
Submission received: 19 January 2025 / Revised: 3 March 2025 / Accepted: 10 March 2025 / Published: 13 March 2025
(This article belongs to the Special Issue Minimally Invasive Surgical Treatments in Kidney Cancer: Clinical Implications, Risk Assessment, and Outcomes)
Browse Figure
Review Reports Versions Notes

Simple Summary

Ablative modalities such as cryoablation (CA), microwave ablation (MWA), and radiofrequency ablation (RFA) offer effective treatment for small renal masses in carefully selected patients. However, tumor recurrence after primary ablation remains a significant challenge. Currently, there is no consensus on the optimal minimally invasive salvage approach for managing recurrence after primary ablation. This review includes the largest accumulated series of patients to date with recurrence of cancer after primary renal ablation. We present the outcomes of various minimally invasive strategies, including repeat ablation, laparoscopic or robotic partial/radical nephrectomy, and active surveillance. By providing a comprehensive understanding of these approaches, this review supports risk-stratified clinical decision-making to enhance outcomes for patients experiencing tumor recurrence after renal mass ablation.

Abstract

Objectives: Thermal ablation has emerged as an effective, nephron-sparing treatment for small renal masses (SRMs), particularly in patients with comorbidities. However, tumor recurrence remains a challenge, necessitating evidence-based approaches for salvage management. This review examines the outcomes of minimally invasive modalities for managing recurrence following the primary ablation of SRMs. Methods: A literature review was conducted using the Medline database, following PRISMA guidelines. Studies published between 1981 and 2024 were screened based on predefined PICO criteria. Inclusion focused on patients with tumor recurrence after primary ablation therapy who underwent minimally invasive salvage treatments including repeat ablation, laparoscopic/robotic partial or radical nephrectomy, or active surveillance. Data extracted included patient demographics, initial treatments, recurrence timelines, salvage modalities, and outcomes. Results: Of 364 patients across 29 studies, 249 (68.4%) underwent re-ablation, 82 (22.5%) were treated with laparoscopic/robotic partial or radical nephrectomy, and 33 (9%) were managed with active surveillance. Among 249 patients with re-ablation, 179 (71.9%) showed no evidence of disease, 67 (26.9%) experienced recurrence, and outcomes were indeterminate in 3 (1.2%). Salvage minimally invasive partial or radical nephrectomy outcomes were available for 64 cases, with 63 (98.4%) showing no recurrence. In 33 patients under active surveillance, 4 died, 4 underwent surgery, and 25 remained under monitoring, though follow-up data were limited. Conclusion: Minimally invasive salvage modalities, such as re-ablation and laparoscopic/robotic partial or radical nephrectomy, effectively manage tumor recurrence, achieving >70% and >98% oncological success, respectively, despite technical challenges. Future studies directly comparing these modalities are essential for establishing standardized protocols for salvage management.

1. Introduction

Kidney cancer, now the 12th most common malignancy worldwide, is on the rise, with an estimated 400,000 new cases and 175,000 deaths annually. Around 50% of new patients are diagnosed with stage I renal cell carcinoma (RCC) (T1a), with reports showing an increase in the prevalence of this rate from 43% to 57% between 1993 and 2004 [1]. A small renal mass (SRM) is consistent with the definition of clinical stage I kidney tumors (cT1a) as incidentally detected, small-size (<4 cm), contrast-enhancing solid or cystic lesions [2]. When approaching patients with SRM, nephron-sparing procedures should be prioritized. Ablative modalities have emerged as a viable alternative for managing cT1a solid renal masses, particularly those smaller than 3 cm, as recommended by the American Urological Association (AUA) guidelines [3]. These therapies demonstrate favorable efficacy and excellent safety profiles, contributing to their growing utilization. With advantages such as low postoperative morbidity and renal function preservation, ablative techniques are confidently employed by radiologists and urologists through percutaneous and laparoscopic approaches [4,5]. Common ablation modalities include cryoablation (CA), microwave ablation (MWA), radiofrequency ablation (RFA), high-intensity focused ultrasound (HIFU), and irreversible electroporation (IRE) [6,7].
Recurrence rates following ablative techniques vary, ranging from 1 to 9% based on the method and approach employed [8]. CA and RFA show comparable recurrence rates, with CA exhibiting local recurrence rates of about 7.2%. RFA recurrence rates range from 4.2% in T1a to 14.3% in T1b tumors, with tumor stage being a key predictor of recurrence risk. Microwave ablation (MWA) demonstrates lower recurrence rates (2–5% at 1 year) compared to CA but similar rates at 5 years, likely due to its higher intertumoral temperature and larger ablation zone [8]. Most recurrences are detected within the first five years after the procedure [9]. Given the higher recurrence rates associated with ablative therapies compared to partial or radical nephrectomy, it is crucial to establish a well-structured follow-up strategy and provide salvage modalities to address the treatment failures [3].
There is currently no consensus on the optimal treatment for management of tumor recurrence following ablative therapies. Re-ablation, partial or radical nephrectomy, and active surveillance remain the primary management strategies employed to address post-ablation tumor recurrence [10]. Re-ablation is commonly used due to its demonstrated efficacy and acceptable complication rates, particularly in older patients with higher comorbidities [11]. Despite technical difficulties posed by fibrosis from primary ablation treatments, laparoscopic/robotic partial and radical nephrectomy remain viable treatment options in selected cases [12].
This literature review aims to present the outcomes of various minimally invasive approaches for the management of tumor recurrence following the primary ablation of small renal masses. To our knowledge, this is the largest accumulated series of patients with recurrence after renal mass ablation who were managed with minimally invasive modalities (including active surveillance).

2. Material and Methods

A systematic literature review was conducted using the Medline (PubMed) database, adhering to the 2020 Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) protocol for reporting [13]. The protocol has not been registered. Various combinations of the following keywords were used to identify relevant articles: salvage, therapy, recurrent, kidney, cancer, ablation, renal retreatment, mass, ablative, nephrectomy, MWA, RFA, HIFU, CA, partial, radical, robotic, percutaneous, laparoscopic, and minimally invasive surgery. The search results were filtered by species (human), publication type (article), language (English), and publication year (1981 to 2024).
Studies were selected based on the PICO criteria: [patient, intervention, comparator, outcome] [14].
  • (P) Adults (>18 years) with prior ablative therapy for renal cancer presenting with tumor recurrence during follow-up period.
  • (I) Minimally invasive treatment for tumor recurrence after primary ablation, including re-ablation, laparoscopic or robotic partial or radical nephrectomy, and active surveillance.
  • (C) Comparisons between different re-treatment modalities regarding outcomes, follow-up, and other relevant factors.
  • (O) Outcomes of interest included primary and secondary treatment success, retreatment outcomes (e.g., disease recurrence, metastasis, death, successful treatment or no evidence of disease (NED)), tumor types and stages, time to recurrence, follow-up duration, and patient characteristics like age and gender, if available.
Figure 1 illustrates the study selection process following the PRISMA protocol. The initial search identified 2064 studies published between 1981 and 2024 using various keyword combinations. Sixty additional studies were included after reviewing the reference lists of relevant studies to identify further management strategies for recurrence after ablative therapies and their outcomes. Of these, 14 were excluded due to duplication. After screening titles and abstracts for our eligibility criteria, 1945 articles were excluded. The full texts of the remaining 165 articles were studied; an additional 136 studies were excluded. These exclusions encompassed studies with an open surgery approach for salvage treatments, review articles, editorial comments, editor letters, and conference abstracts. Moreover, 35 additional studies were excluded despite meeting our initial criteria, due to missed critical data, such as the procedure or patients’ outcomes [15,16,17,18,19,20,21,22,23,24,25,26,27,28,29,30,31,32,33,34,35,36,37,38,39,40,41,42,43,44,45,46,47,48,49]. A full-text review of the remaining studies resulted in the inclusion of 29 studies, which collectively evaluated 364 patients [12,50,51,52,53,54,55,56,57,58,59,60,61,62,63,64,65,66,67,68,69,70,71,72,73,74,75,76,77]. Out of the 29 included studies, 24 were retrospective cohort studies, 4 were prospective cohort studies, and 1 was a case series.
Demographic data, including the type of initial ablative therapy; the time interval between the first treatment and recurrence; patient age; the type of secondary retreatment management, tumor pathology, and stage; re-treatment outcomes; and follow-up duration, were systematically collected. These data formed the basis of our analysis and enabled a comparative evaluation of minimally invasive approaches (including active surveillance) for managing tumor recurrence after primary ablation.
Two authors independently performed article screening, selection, and data extraction. The senior author supervised the process and resolved any disagreements. This approach ensures a transparent and reliable review process, minimizing potential biases and enhancing the credibility of our conclusions.

3. Results

As mentioned above, we extracted and analyzed the data of 364 patients from 29 studies. These patients underwent minimally invasive modalities (including active surveillance) for management of tumor recurrence following primary renal mass ablation (Table 1). Six studies focused exclusively on laparoscopic or robotic-assisted partial or radical nephrectomy as a secondary salvage approach; ten studies evaluated repeat ablation as the primary modality; and thirteen studies investigated both minimally invasive nephrectomy (partial or radical) and repeat ablation for recurrence management. In eight studies, active surveillance was chosen as the management option for some patients while other options were selected for the rest of patients.
Table 1. Summary of studies (n = 29) addressing minimally invasive or active surveillance approach for management of failures after primary ablation of small renal mass. Some studies presented multiple modalities.
Table 1. Summary of studies (n = 29) addressing minimally invasive or active surveillance approach for management of failures after primary ablation of small renal mass. Some studies presented multiple modalities.
1Study TypeMean Age
(Year)		Tumor Size (cm)Tumor Histology Mean Time to Recurrence (Month)Secondary Treatment Modality (No of Cases)OutcomeMean Follow-Up
(Month)
Gupta et al., 2009 [58]Retrospective Cohort55.52RCC5.5RFA (2)2 NED20.3
Ferakis et al., 2010 [57]Prospective Cohort62.34.46-32RFA (3)NED58.66
Liu et al., 2017 [61]Retrospective Cohort->4ccRCC-RFA (5)4 NED
1 Rec		77
Lorber et al., 2014 [64]Retrospective Cohort-2.72 ccRCC
1 RCC		86RFA (3)NED65.6
Matsumoto et al., 2005 [65]Retrospective Cohort-1RCC<6RFA (1)Rec18
Ji et al., 2016 [59]Retrospective Cohort723.2ccRCC20RFA (1)NED48
Psutka et al., 2013 [70]Retrospective Cohort-<7RCC30RFA (6)5 NED
1 Rec		45
AS (6)
Stern et al., 2007 [72]Retrospective Cohort-<4ccRCC18RFA (1)NED12
Long et al., 2017 [63]Retrospective Cohort--RCC13.1RFA (13)
CA (2)		14 NED
1 Rec		38
Tracy et al., 2010 [74]Retrospective Cohort--RCC9.66RFA (2)
CA (1)
AS (1)		2 NED
1 Rec
Death		-
Caputo et al., 2017 [52]Retrospective Cohort----CA (2)1 NED
1 Rec		30.1
AS (2)
Emara et al., 2014 [55]Prospective cohort ---CA (2)NED31.3
Murray et al., 2019 [66]Retrospective Cohort-<45 RCC
1 RO		-CA (6)5 NED
1 Rec		53
Okhunov et al., 2016 [67]Retrospective Cohort64.82.414 ccRCC
3 pRCC
4 chRCC		32CA (20)17 NED
3 Rec		30
Patel et al., 2020 [69]Retrospective Cohort74<4--CA (5)NED42.7
Yanagisawa et al., 2022 [75]Retrospective Cohort74<720 ccRCC
2 pRCC		-CA (22)20 NED
2 Rec		33
AS (3)
Rembeyo et al., 2020 [71]Retrospective Cohort---13CA (6)
AS (5)		6 NED
2 Deaths		29
Sundelin et al. 2019 [73]Retrospective Cohort66.5355 ccRCC
5 pRCC
7 chRCC
5 not specified		11.44CA (72)31 NED
38 Rec
3 Lost in F/U		23
Breen et al., 2013 [51]prospective Cohort67-RCC12Ablation (1)NED18
Pandolfo et al., 2023 [68]Retrospective Cohort----Ablation (8)NED45
Yang et al., 2013 [76]Retrospective Cohort-3.36RCC12.33Ablation (3)
AS (1)		NED
70.6
Attawettayanon et al., 2024 [50] 64.82.3-28Ablation (12)7 NED
5 Rec		53
Retrospective Cohort RN (2)Unknown
Loloi et al., 2020 [62]Retrospective Cohort-3.151 ccRCC
13 pRCC
2 chRCC
3 benign
8 non-diagnostics		13.7Ablation (50)
AS (14)		38 NED
12 Rec		28
- PN (5)
RN (8)		Unknown
Long et al., 2017 [63]Retrospective Cohort--RCC13.1PN (1)
RN (2)		NED38
Patel et al., 2020 [69]Retrospective Cohort74< 4--PN (1)
RN (3)		NED42.7
Rembeyo et al., 2020 [71]Retrospective Cohort---13RPN (1)
RRN (2)		NED29
Duffey et al., 2012 [54]Retrospective Cohort--RCC24.5RPN (2)
LRN (1)
AS (1)		NED(1)
Unknown (2)
Death		70
Martini et al., 2021 [12]Retrospective Cohort78<4RCC26RPN (35)NED43
Feng et al., 2024 [56]Case Series592.5RCC-RPN (1)NED24
Ferakis et al., 2010 [57]Prospective Cohort585.1pRCC12RN (1)NED78
Gupta et al., 2009 [58]Retrospective Cohort582.65ccRCC16.5RN (2)NED20.3
Zhou et al.,
2021 [77]		Retrospective Cohort743.4RCC<24RN (2)NED9.5
Caputo et al., 2017 [52]Retrospective Cohort----LRN (1)NED30.1
Lorber et al., 2014 [64]Retrospective Cohort-4ccRCC42LRN (1)NED65.6
Yanagisawa et al., 2022 [75]Retrospective Cohort74<7--RRN (1)Unknown33
Chang et al., 2015 [53]Retrospective Cohort--RCC-LRN (2)NED67.6
Stern et al., 2007 [72]Retrospective Cohort-<4ccRCC24LRN (1)NED12
Klatte et al., 2011 [60]Retrospective Cohort-2.5ccRCC14LRN (4)NED-
Ji et al., 2016 [59]Retrospective Cohort58.53.5ccRCC15LRN (2)1 NED
1 Death		78
Tracy et al., 2010 [74]Retrospective Cohort--RCC12LRN (1)NED36
NED: No Evidence of Disease; RFA: Radiofrequency Ablation; CA: Cryoablation; Rec: Recurrence; AS: Active Surveillance; PN: Partial Nephrectomy; RN: Radical Nephrectomy; L: Laparoscopic; R: Robotic; RCC: Renal Cell Carcinoma; ccRCC: Clear-Cell Renal Cell Carcinoma; chRCC: Chromophobe Renal Cell Carcinoma; pRCC: Papillary Renal Cell Carcinoma; RO: Renal Oncocytoma.
All the patients included in this review had tumor recurrence after primary ablative therapy (n = 364). As shown in Table 2, most of these patients had undergone CA (198 cases: 54.3%) and RFA (123 cases: 33.7%) as their primary method of ablation.
For the management of tumor recurrence after primary ablation among the 364 patients included in this review, 249 patients (68.4%) underwent a second ablation therapy, 82 cases (22.5%) were treated with laparoscopic/robotic partial or radical nephrectomy, and 33 cases (9%) were managed with active surveillance (Table 3).
Of the 249 patients who underwent re-ablation for tumor recurrence, 179 (71.9%) had no evidence of disease (recurrence) during follow-up. Tumor recurrence was observed in 67 cases (26.9%), while the procedural outcomes could not be determined in 3 (1.2%) patients. Among 82 cases treated with laparoscopic/robotic partial or radical nephrectomy, the outcomes for 18 cases (21.9%) were either unavailable or the patients were lost to follow-up. Among the remaining 64 patients with reported treatment outcome, only one patient experienced recurrence and succumbed to the disease, while 63 patients were successfully treated with no recurrence reported during follow-up period.
Regarding the 33 patients managed with active surveillance, there were significant limitations in obtaining follow-up details and outcomes. Of the reported cases, four patients died during follow-up, four eventually underwent surgery, and 25 remained under active monitoring. Comprehensive information on secondary treatment outcomes is presented in Table 4.

4. Discussion

Since 2017, the AUA guidelines have recommended ablation therapy as an alternative option for managing cT1a solid renal masses (<4 cm in size) [78]. These SRMs are generally characterized by slow growth, a low-grade histology, and a minimal tendency for metastasis [79]. While partial nephrectomy remains the standard of care for cT1a renal masses, thermal ablation and active surveillance are particularly viable options for managing the disease in older patients with significant comorbidities [78].
As for the common urologic and nonurological complications related to these modalities described by the AUA meta-analysis, partial nephrectomy was associated with a significantly higher rate of urologic complications (9%) compared to CA (5%) and RFA (6%). Major nonurological complications, on the other hand, were comparable across these modalities (~5%). Additionally, the transfusion rate was significantly higher in LPN (6%) relative to CA (3%) and RFA (2%). Notably, the reintervention rates were statistically similar between partial nephrectomy and ablation modalities (3%) [78].
According to the current AUA guidelines, patients undergoing ablative procedures should have contrast-enhanced imaging both before and within six months after treatment if biopsy results indicate malignant or nondiagnostic tumors [78]. At most institutions, computed tomography (CT) or magnetic resonance imaging (MRI) is performed within the first month after the ablation to detect residual tumors (i.e., failed ablation) and to establish a baseline imaging of the ablation zone. Protocols for detecting recurrence after the negative initial follow-up imaging vary by institution. Typically, three to four imaging studies are performed during the first year, followed by imaging every 6 to 12 months in subsequent years [80]. For monitoring patients after primary ablation, AUA guidelines recommend a low-risk postoperative follow-up protocol that involves medical history reviews, physical examination, laboratory testing, abdominal imaging, and chest imaging at specified intervals (6, 12, 24, 36, 48, 60, 72–84, and 96–120 months) [3].
In our review, about 65% of recurrences were identified between 6 and 30 months after primary ablation. However, several studies documented recurrences that may occur as late as 54 months, highlighting the importance of long-term imaging to detect late recurrence after primary ablation. Stewart et al. demonstrated that adherence to the 2014 AUA guideline imaging recommendations for low-risk cases could miss at least 60% of recurrences if follow-up is limited to three years [81].
Interpreting findings on post-procedure CT and MRI scans requires expertise in recognizing the unique imaging features of the ablation zone. For instance, benign peri-ablation enhancement, commonly observed on post-procedure imaging, may persist for months before resolving. Additionally, homogenous contrast enhancement of the ablation zone immediately after RFA can mimic tumor recurrence [82,83]. One study reported that 1 in 5 patients (20%) treated with CA showed peripheral rim enhancement of the treatment zone at three months after the ablation, which decreased by approximately 5% per year during follow-up. By the end of the study, only 1.8% of their patients remained suspicious of having residual tumors [25].
Therefore, active surveillance can play a crucial role after renal ablation, enabling the monitoring of imaging findings and the distinguishing of benign post-treatment phenomena and true tumor recurrence. To avoid overtreatment, Breda et al. proposed one-year surveillance as a safe management strategy for patients presenting with early enhancement on scans following CA or RFA [84].
There is currently no consensus on the optimal management modality for tumor recurrence following ablative therapies. Re-ablation, partial or radical nephrectomy, and active surveillance remain the primary management strategies for addressing post-ablation tumor recurrence [10]. All cases included in this review involved patients diagnosed with tumor recurrence after primary ablation who opted for active surveillance or a minimally invasive salvage modality such as re-ablation or laparoscopic/robotic partial or radical nephrectomy. Higher comorbidity indices among patients undergoing primary ablation and concerns about adhesions and surgical complications may lead many clinicians to favor ablation for managing recurrent tumors after primary ablation.
In this review, of the 364 analyzed patients, 249 (68.4%) underwent salvage ablation; the majority (>90%) of these patients were followed for more than 20 months (range 10–132 months). Of the 249 patients who underwent re-ablation for tumor recurrence following primary ablation, 179 (71.8%) patients achieved successful second ablation, with no evidence of disease during follow-up. Sixty-seven patients (26.9%) experienced new recurrences following secondary ablation, while three were lost to follow-up.
The 71.8% success rate of second ablation observed in our review closely aligns with the 76% success rate (38 out of 50 cases) reported in a prior cohort study on the management of residual or recurrent disease following the thermal ablation of renal cortical tumors [62]. Interestingly, four studies included in our review documented outcomes of a third retreatment attempt in 12 patients with recurrences after the second ablation. Among these, two patients underwent successful salvage nephrectomy, seven patients achieved successful tertiary ablations, and three cases were observed after a failed tertiary ablation.
While the overall success rate of second ablations is promising, it is imperative to counsel patients on the chance of failure and the need for proceeding with partial/radical nephrectomy. This approach ensures informed decision-making before treatment.
In the case of a nephrectomy after primary ablation, although partial nephrectomy as a nephron-sparing procedure is often prioritized, post-ablation fibrosis, adhesions, and associated complications may necessitate intraoperative conversion to radical nephrectomy. These patients should be counseled about the complexity of partial nephrectomy and the potential need for conversion to radical nephrectomy [37].
Notably, despite these concerns, 82 (22.5%) patients in the current series underwent successful laparoscopic/robotic partial or radical nephrectomy, comprising 46 robotic partial nephrectomy (56.1%) and 36 robotic/laparoscopic radical nephrectomy (43.9%) cases. Most salvage nephrectomy cases (~77%) in this review were followed for at least 30–50 months. Among the 64 cases with reported outcomes, all but one patient (who died of cancer) were successfully treated with no evidence of disease during follow-up. For example, Martini et al., reported on 35 patients with tumor recurrence after primary ablation, all of whom were managed with robotic partial nephrectomy, achieving successful outcomes with no instances of recurrence during their follow-up [12].
Overall, while salvage partial or radical nephrectomy in post-ablation settings might be associated with some technical challenges, it can be performed safely in carefully selected patients and yields excellent postoperative outcomes. Future studies directly comparing the outcomes of re-ablation versus minimally invasive nephrectomy are necessary to provide more robust evidence supporting the optimal salvage treatment modality in this setting. Clinical decision-making for tumor recurrence after ablation
When determining the optimal treatment for tumor recurrence following primary ablation, a thorough assessment of the patient’s overall health, comorbidities, tumor characteristics, and procedural considerations is paramount. Robotic partial nephrectomy, when performed by experienced surgeons, offers a high rate of disease control and remains the preferred minimally invasive nephron-sparing approach. However, in patients with significant comorbidities or those less suitable for surgery, re-ablation presents a viable, less invasive alternative with an acceptable success rate. Radical nephrectomy is generally reserved for cases where tumors exhibit adverse features or have high nephrometry scores, necessitating a more aggressive approach.
Active surveillance plays a pivotal role in evaluating both patient status and tumor dynamics, ensuring timely intervention when clinically warranted. This approach is particularly beneficial for patients with small renal masses and substantial comorbidities, where the risks of immediate intervention may outweigh potential benefits. Additionally, surveillance helps differentiate benign post-treatment imaging findings from true tumor recurrence, thereby optimizing patient management and reducing unnecessary procedures. Given the complexity of decision-making in tumor recurrence, individualized management strategies tailored to patient and tumor-specific factors remain essential.
Our review study has several limitations. The scarcity of studies specifically reporting on patients with local recurrence following primary ablation required extensive efforts to identify and analyze matching cases in the literature. A significant number of studies had to be excluded due to insufficient outcome data or the inability to extract relevant case outcomes from pooled datasets. Furthermore, the available data sometimes lacked granularity; some of the studies only provided the number of cases and their outcomes without critical information, such as tumor size, which limited our ability to perform detailed analyses. Variability in physician expertise and the method of ablation procedures may also have contributed to heterogeneity in the reported outcomes. Due to the rarity of the condition, we included and analyzed various retrospective and prospective cohorts, as well as case series, in this systematic review. However, the inherent heterogeneity of samples and study designs remains a common limitation of many systematic reviews, potentially affecting the generalizability of findings. Despite these limitations, this review collected a large series of patients who underwent various salvage minimally invasive treatment modalities after failed primary ablation.

5. Conclusions

This review highlights the outcomes of various minimally invasive management strategies for tumor recurrence following the primary ablation of small renal masses, including repeat ablation, laparoscopic/robotic partial and radical nephrectomy, and active surveillance. Our findings underscore the efficacy of a second thermal ablation as a salvage treatment, achieving disease control in more than 70% of patients, while minimally invasive partial or radical nephrectomy demonstrated excellent oncological control (>98%) in carefully selected patients despite technical challenges. Active surveillance can also be considered as a viable option for tumors with indolent features in patients with comorbidities. Surveillance is also a non-invasive approach to distinguish benign post-treatment changes from true recurrence. The variability in timing of recurrence following primary ablation (e.g., the chance of recurrence beyond 30 months) highlights the critical importance of long-term follow-up after ablation to optimize patient outcomes. Longitudinal studies comparing nephrectomy versus re-ablation with extended follow-up are essential to further define the role of these strategies and establish standardized protocols for managing tumor recurrence after primary ablation.

Author Contributions

Conceptualization, A.A.; methodology, M.A. and A.A.; validation, A.A. and M.A.; formal analysis, M.A.; investigation, M.A.; resources, M.A.; data curation, M.A.; writing, M.A.; review and editing, A.A. and M.A.; visualization, A.A. and M.A.; supervision, A.A.; project administration, A.A. All authors have read and agreed to the published version of the manuscript.

Funding

This research received no external funding. The APC was funded by the Department of Urology, PennState Health, Hershey Medical Center, Hershey, Pennsylvania, United States.

Conflicts of Interest

The authors declare no conflicts of interest.

References

  1. Kane, C.J.; Mallin, K.; Ritchey, J.; Cooperberg, M.R.; Carroll, P.R. Renal cell cancer stage migration: Analysis of the National Cancer Data Base. Cancer 2008, 113, 78–83. [Google Scholar] [CrossRef] [PubMed]
  2. Maroni, P.; Moss, J. Nephron-sparing surgery. Semin. Interv. Radiol. 2014, 31, 104–106. [Google Scholar] [CrossRef]
  3. Campbell, S.C.; Uzzo, R.G.; Karam, J.A.; Chang, S.S.; Clark, P.E.; Souter, L. Renal Mass and Localized Renal Cancer: Evaluation, Management, and Follow-up: AUA Guideline: Part II. J. Urol. 2021, 206, 209–218. [Google Scholar] [CrossRef] [PubMed]
  4. Abbosh, P.H.; Bhayani, S.B. Thermoablation of Renal Masses: The Urologist’s Perspective. Semin. Interv. Radiol. 2011, 28, 361–366. [Google Scholar] [CrossRef] [PubMed]
  5. Mouli, S.K.; McDevitt, J.L.; Su, Y.K.; Ragin, A.B.; Gao, Y.; Nemcek, A.A., Jr.; Lewandowski, R.J.; Salem, R.; Sato, K.T. Analysis of the RENAL and mRENAL Scores and the Relative Importance of Their Components in the Prediction of Complications and Local Progression after Percutaneous Renal Cryoablation. J. Vasc. Interv. Radiol. 2017, 28, 860–867. [Google Scholar] [CrossRef]
  6. Klingler, H.C.; Susani, M.; Seip, R.; Mauermann, J.; Sanghvi, N.; Marberger, M.J. A novel approach to energy ablative therapy of small renal tumours: Laparoscopic high-intensity focused ultrasound. Eur. Urol. 2008, 53, 810–816; discussion 817–818. [Google Scholar] [CrossRef]
  7. Wagstaff, P.; Ingels, A.; Zondervan, P.; de la Rosette, J.J.; Laguna, M.P. Thermal ablation in renal cell carcinoma management: A comprehensive review. Curr. Opin. Urol. 2014, 24, 474–482. [Google Scholar] [CrossRef]
  8. Aveta, A.; Iossa, V.; Spena, G.; Conforti, P.; Pagano, G.; Dinacci, F.; Verze, P.; Manfredi, C.; Ferro, M.; Lasorsa, F.; et al. Ablative Treatments for Small Renal Masses and Management of Recurrences: A Comprehensive Review. Life 2024, 14, 450. [Google Scholar] [CrossRef]
  9. Adamy, A.; Chong, K.T.; Chade, D.; Costaras, J.; Russo, G.; Kaag, M.G.; Bernstein, M.; Motzer, R.J.; Russo, P. Clinical characteristics and outcomes of patients with recurrence 5 years after nephrectomy for localized renal cell carcinoma. J. Urol. 2011, 185, 433–438. [Google Scholar] [CrossRef]
  10. Cross, B.W.; Parker, D.C.; Cookson, M.S. Salvage Surgery After Renal Mass Ablation. Urol. Clin. N. Am. 2017, 44, 305–312. [Google Scholar] [CrossRef]
  11. Singer, E.A.; Bratslavsky, G. Management of locally recurrent kidney cancer. Curr. Urol. Rep. 2010, 11, 15–21. [Google Scholar] [CrossRef] [PubMed]
  12. Martini, A.; Turri, F.; Barod, R.; Rocco, B.; Capitanio, U.; Briganti, A.; Montorsi, F.; Mottrie, A.; Challacombe, B.; Lagerveld, B.W.; et al. Salvage Robot-assisted Renal Surgery for Local Recurrence After Surgical Resection or Renal Mass Ablation: Classification, Techniques, and Clinical Outcomes. Eur. Urol. 2021, 80, 730–737. [Google Scholar] [CrossRef] [PubMed]
  13. Page, M.J.; McKenzie, J.E.; Bossuyt, P.M.; Boutron, I.; Hoffmann, T.C.; Mulrow, C.D.; Shamseer, L.; Tetzlaff, J.M.; Akl, E.A.; Brennan, S.E.; et al. The PRISMA 2020 statement: An updated guideline for reporting systematic reviews. BMJ 2021, 372, n71. [Google Scholar] [CrossRef]
  14. Eriksen, M.B.; Frandsen, T.F. The impact of patient, intervention, comparison, outcome (PICO) as a search strategy tool on literature search quality: A systematic review. J. Med. Libr. Assoc. 2018, 106, 420–431. [Google Scholar] [CrossRef]
  15. Beksac, A.T.; Carbonara, U.; Abou Zeinab, M.; Meagher, M.; Hemal, S.; Tafuri, A.; Tuderti, G.; Antonelli, A.; Autorino, R.; Simone, G.; et al. Redo Robotic Partial Nephrectomy for Recurrent Renal Tumors: A Multi-Institutional Analysis. J. Endourol. 2022, 36, 1296–1301. [Google Scholar] [CrossRef]
  16. Bersang, A.B.; Søndergaard Mosholt, K.S.; Verner Jensen, C.; Germer, U.; Holm, M.; Røder, M.A. Safety and oncological outcome following radiofrequency ablation of small renal masses in a single center. Scand. J. Urol. 2021, 55, 203–208. [Google Scholar] [CrossRef]
  17. Bertolo, R.; Garisto, J.; Armanyous, S.; Agudelo, J.; Lioudis, M.; Kaouk, J. Perioperative, oncological and functional outcomes after robotic partial nephrectomy vs. cryoablation in the elderly: A propensity score matched analysis. Urol. Oncol. Semin. Orig. Investig. 2019, 37, 294-e9. [Google Scholar] [CrossRef]
  18. Bianchi, L.; Chessa, F.; Piazza, P.; Ercolino, A.; Mottaran, A.; Recenti, D.; Serra, C.; Gaudiano, C.; Cappelli, A.; Modestino, F.; et al. Percutaneous ablation or minimally invasive partial nephrectomy for cT1a renal masses? A propensity score-matched analysis. Int. J. Urol. 2022, 29, 222–228. [Google Scholar] [CrossRef]
  19. Chan, P.; Vélasco, S.; Vesselle, G.; Boucebci, S.; Herpe, G.; Debaene, B.; Ingrand, P.; Irani, J.; Tasu, J.P. Percutaneous microwave ablation of renal cancers under CT guidance: Safety and efficacy with a 2-year follow-up. Clin. Radiol. 2017, 72, 786–792. [Google Scholar] [CrossRef]
  20. Clark, T.W.; Malkowicz, B.; Stavropoulos, S.W.; Sanchez, R.; Soulen, M.C.; Itkin, M.; Patel, A.; Mondschein, J.I.; Wein, A.J. Radiofrequency ablation of small renal cell carcinomas using multitined expandable electrodes: Preliminary experience. J. Vasc. Interv. Radiol. 2006, 17, 513–519. [Google Scholar] [CrossRef]
  21. De Filippo, M.; Ziglioli, F.; Russo, U.; Pagano, P.; Brunese, L.; Bertelli, E.; Pagnini, F.; Maestroni, U. Radiofrequency ablation (RFA) of T1a renal cancer with externally cooled multitined expandable electrodes. Radiol. Med. 2020, 125, 790–797. [Google Scholar] [CrossRef] [PubMed]
  22. Fraisse, G.; Colleter, L.; Peyronnet, B.; Khene, Z.E.; Mandoorah, Q.; Soorojebally, Y.; Bourgi, A.; De La Taille, A.; Roupret, M.; De Kerviler, E.; et al. Peri-operative and local control outcomes of robot-assisted partial nephrectomy vs percutaneous cryoablation for renal masses: Comparison after matching on radiological stage and renal score. BJU Int. 2019, 123, 632–638. [Google Scholar] [CrossRef] [PubMed]
  23. Guan, W.; Bai, J.; Liu, J.; Wang, S.; Zhuang, Q.; Ye, Z.; Hu, Z. Microwave ablation versus partial nephrectomy for small renal tumors: Intermediate-term results. J. Surg. Oncol. 2012, 106, 316–321. [Google Scholar] [CrossRef]
  24. Guillotreau, J.; Haber, G.-P.; Autorino, R.; Miocinovic, R.; Hillyer, S.; Hernandez, A.; Laydner, H.; Yakoubi, R.; Isac, W.; Long, J.-A.; et al. Robotic Partial Nephrectomy Versus Laparoscopic Cryoablation for the Small Renal Mass. Eur. Urol. 2012, 61, 899–904. [Google Scholar] [CrossRef]
  25. Hegarty, N.J.; Gill, I.S.; Desai, M.M.; Remer, E.M.; O’Malley, C.M.; Kaouk, J.H. Probe-ablative nephron-sparing surgery: Cryoablation versus radiofrequency ablation. Urology 2006, 68, 7–13. [Google Scholar] [CrossRef]
  26. Jasinski, M.; Bielinska, M.; Siekiera, J.; Kamecki, K.; Salagierski, M. Ultrasound-Guided Percutaneous Thermal Ablation of Renal Cancers—In Search for the Ideal Tumour. Cancers 2023, 15, 518. [Google Scholar] [CrossRef]
  27. Jiménez, J.A.; Zhang, Z.; Zhao, J.; Abouassaly, R.; Fergany, A.; Gong, M.; Kaouk, J.; Krishnamurthi, V.; Stein, R.; Stephenson, A.; et al. Surgical Salvage of Thermal Ablation Failures for Renal Cell Carcinoma. J. Urol. 2016, 195, 594–600. [Google Scholar] [CrossRef]
  28. Karam, J.A.; Wood, C.G.; Compton, Z.R.; Rao, P.; Vikram, R.; Ahrar, K.; Matin, S.F. Salvage surgery after energy ablation for renal masses. BJU Int. 2015, 115, 74–80. [Google Scholar] [CrossRef]
  29. Konstantinidis, C.; Trilla, E.; Serres, X.; Montealegre, C.; Lorente, D.; Castellón, R.; Morote, J. Association among the R.E.N.A.L. nephrometry score and clinical outcomes in patients with small renal masses treated with percutaneous contrast enhanced ultrasound radiofrequency ablation. Cent. Eur. J. Urol. 2019, 72, 92–99. [Google Scholar] [CrossRef]
  30. Kowalczyk, K.J.; Hooper, H.B.; Linehan, W.M.; Pinto, P.A.; Wood, B.J.; Bratslavsky, G. Partial nephrectomy after previous radio frequency ablation: The National Cancer Institute experience. J. Urol. 2009, 182, 2158–2163. [Google Scholar] [CrossRef]
  31. Levinson, A.W.; Su, L.M.; Agarwal, D.; Sroka, M.; Jarrett, T.W.; Kavoussi, L.R.; Solomon, S.B. Long-term oncological and overall outcomes of percutaneous radio frequency ablation in high risk surgical patients with a solitary small renal mass. J. Urol. 2008, 180, 499–504; discussion 504. [Google Scholar] [CrossRef] [PubMed]
  32. Ma, Y.; Bedir, S.; Cadeddu, J.A.; Gahan, J.C. Long-term outcomes in healthy adults after radiofrequency ablation of T1a renal tumours. BJU Int. 2014, 113, 51–55. [Google Scholar] [CrossRef] [PubMed]
  33. Margue, G.; Michiels, C.; Allenet, C.; Dupitout, L.; Ricard, S.; Jambon, E.; Blanc, P.; Alezra, E.; Estrade, V.; Capon, G.; et al. Feasibility of salvage robotic partial nephrectomy after ablative treatment failure (UroCCR-62 study). Minerva Urol. Nephrol. 2022, 74, 209–215. [Google Scholar] [CrossRef] [PubMed]
  34. Matin, S.F.; Ahrar, K.; Cadeddu, J.A.; Gervais, D.A.; McGovern, F.J.; Zagoria, R.J.; Uzzo, R.G.; Haaga, J.; Resnick, M.I.; Kaouk, J.; et al. Residual and recurrent disease following renal energy ablative therapy: A multi-institutional study. J. Urol. 2006, 176, 1973–1977. [Google Scholar] [CrossRef]
  35. Mayo-Smith, W.W.; Dupuy, D.E.; Parikh, P.M.; Pezzullo, J.A.; Cronan, J.J. Imaging-guided percutaneous radiofrequency ablation of solid renal masses: Techniques and outcomes of 38 treatment sessions in 32 consecutive patients. AJR Am. J. Roentgenol. 2003, 180, 1503–1508. [Google Scholar] [CrossRef]
  36. McDougal, W.S.; Gervais, D.A.; McGovern, F.J.; Mueller, P.R. Long-term followup of patients with renal cell carcinoma treated with radio frequency ablation with curative intent. J. Urol. 2005, 174, 61–63. [Google Scholar] [CrossRef]
  37. Nguyen, C.T.; Lane, B.R.; Kaouk, J.H.; Hegarty, N.; Gill, I.S.; Novick, A.C.; Campbell, S.C. Surgical Salvage of Renal Cell Carcinoma Recurrence After Thermal Ablative Therapy. J. Urol. 2008, 180, 104–109. [Google Scholar] [CrossRef]
  38. Olweny, E.O.; Park, S.K.; Tan, Y.K.; Best, S.L.; Trimmer, C.; Cadeddu, J.A. Radiofrequency ablation versus partial nephrectomy in patients with solitary clinical T1a renal cell carcinoma: Comparable oncologic outcomes at a minimum of 5 years of follow-up. Eur. Urol. 2012, 61, 1156–1161. [Google Scholar] [CrossRef]
  39. Panhelleux, M.; Balssa, L.; David, A.; Thiery-Vuillemin, A.; Kleinclauss, F.; Frontczak, A. Evaluation of local control after percutaneous microwave ablation versus partial nephrectomy: A propensity score matched study. Fr. J. Urol. 2024, 34, 102534. [Google Scholar] [CrossRef]
  40. Ryoo, H.; Kang, M.; Sung, H.H.; Jeon, H.G.; Jeong, B.C.; Jeon, S.S.; Lee, H.M.; Park, B.K.; Seo, S.I. A Comparison of Functional and Oncologic Outcomes between Partial Nephrectomy and Radiofrequency Ablation in Patients with Chronic Kidney Disease after Propensity Score Matching. Diagnostics 2022, 12, 2292. [Google Scholar] [CrossRef]
  41. Salagierski, M.; Salagierski, M.; Salagierska-Barwińska, A.; Sosnowski, M. Percutaneous ultrasound-guided radiofrequency ablation for kidney tumors in patients with surgical risk. Int. J. Urol. 2006, 13, 1375–1379. [Google Scholar] [CrossRef]
  42. Singh, R.K.; Gideon, M.; Rajendran, R.; Mathew, G.; Nair, K. Advancing Treatment Frontiers: Radiofrequency Ablation for Small Renal Mass-Intermediate-Term Results. J. Kidney Cancer VHL 2023, 10, 1–6. [Google Scholar] [CrossRef] [PubMed]
  43. Takaki, H.; Soga, N.; Kanda, H.; Nakatsuka, A.; Uraki, J.; Fujimori, M.; Yamanaka, T.; Hasegawa, T.; Arima, K.; Sugimura, Y.; et al. Radiofrequency ablation versus radical nephrectomy: Clinical outcomes for stage T1b renal cell carcinoma. Radiology 2014, 270, 292–299. [Google Scholar] [CrossRef]
  44. Uribe, P.S.; Costabile, R.A.; Peterson, A.C. Progression of renal tumors after laparoscopic radiofrequency ablation. Urology 2006, 68, 968–971. [Google Scholar] [CrossRef]
  45. Varkarakis, I.M.; Allaf, M.E.; Inagaki, T.; Bhayani, S.B.; Chan, D.Y.; Su, L.M.; Jarrett, T.W.; Kavoussi, L.R.; Solomon, S.B. Percutaneous radio frequency ablation of renal masses: Results at a 2-year mean followup. J. Urol. 2005, 174, 456–460; discussion 460. [Google Scholar] [CrossRef] [PubMed]
  46. Wasnik, A.P.; Higgins, E.J.; Fox, G.A.; Caoili, E.M.; Davenport, M.S. Yield of Routine Image-Guided Biopsy of Renal Mass Thermal Ablation Zones: 11-Year Experience. Acad. Radiol. 2019, 26, 232–238. [Google Scholar] [CrossRef]
  47. Wessendorf, J.; König, A.; Heers, H.; Mahnken, A.H. Repeat Percutaneous Radiofrequency Ablation of T1 Renal Cell Carcinomas is Safe in Patients with Von Hippel-Lindau Disease. Cardiovasc. Interv. Radiol. 2021, 44, 2022–2025. [Google Scholar] [CrossRef]
  48. Zagoria, R.J.; Traver, M.A.; Werle, D.M.; Perini, M.; Hayasaka, S.; Clark, P.E. Oncologic efficacy of CT-guided percutaneous radiofrequency ablation of renal cell carcinomas. AJR Am. J. Roentgenol. 2007, 189, 429–436. [Google Scholar] [CrossRef]
  49. Zargar, H.; Samarasekera, D.; Khalifeh, A.; Remer, E.M.; O’Malley, C.; Akca, O.; Autorino, R.; Kaouk, J.H. Laparoscopic vs percutaneous cryoablation for the small renal mass: 15-year experience at a single center. Urology 2015, 85, 850–855. [Google Scholar] [CrossRef]
  50. Attawettayanon, W.; Kazama, A.; Yasuda, Y.; Zhang, J.J.H.; Shah, S.; Rathi, N.; Munoz-Lopez, C.; Lewis, K.; Li, J.; Beksac, A.T.; et al. Thermal Ablation Versus Partial Nephrectomy for cT1 Renal Mass in a Solitary Kidney: A Matched Cohort Comparative Analysis. Ann. Surg. Oncol. 2024, 31, 2133–2143. [Google Scholar] [CrossRef]
  51. Breen, D.J.; Bryant, T.J.; Abbas, A.; Shepherd, B.; McGill, N.; Anderson, J.A.; Lockyer, R.C.; Hayes, M.C.; George, S.L. Percutaneous cryoablation of renal tumours: Outcomes from 171 tumours in 147 patients. BJU Int. 2013, 112, 758–765. [Google Scholar] [CrossRef] [PubMed]
  52. Caputo, P.A.; Zargar, H.; Ramirez, D.; Andrade, H.S.; Akca, O.; Gao, T.; Kaouk, J.H. Cryoablation versus Partial Nephrectomy for Clinical T1b Renal Tumors: A Matched Group Comparative Analysis. Eur. Urol. 2017, 71, 111–117. [Google Scholar] [CrossRef] [PubMed]
  53. Chang, X.; Liu, T.; Zhang, F.; Ji, C.; Zhao, X.; Wang, W.; Guo, H. Radiofrequency ablation versus partial nephrectomy for clinical T1a renal-cell carcinoma: Long-term clinical and oncologic outcomes based on a propensity score analysis. J. Endourol. 2015, 29, 518–525. [Google Scholar] [CrossRef]
  54. Duffey, B.; Nguyen, V.; Lund, E.; Koopmeiners, J.S.; Hulbert, J.; Anderson, J.K. Third Prize: Intermediate-Term Outcomes After Renal Cryoablation: Results of a Multi-Institutional Study. J. Endourol. 2012, 26, 15–20. [Google Scholar] [CrossRef]
  55. Emara, A.M.; Kommu, S.S.; Hindley, R.G.; Barber, N.J. Robot—Assisted partial nephrectomy vs laparoscopic cryoablation for the small renal mass: Redefining the minimally invasive ‘gold standard’. BJU Int. 2014, 113, 92–99. [Google Scholar] [CrossRef]
  56. Feng, C.L.; Franco, A.; Ditonno, F.; Manfredi, C.; Chow, A.K.; Autorino, R. Robotic salvage partial nephrectomy following surgical and ablative therapies. Int. Braz. J. Urol. 2024, 50, 373–374. [Google Scholar] [CrossRef]
  57. Ferakis, N.; Bouropoulos, C.; Granitsas, T.; Mylona, S.; Poulias, I. Long-Term Results After Computed-Tomography–Guided Percutaneous Radiofrequency Ablation for Small Renal Tumors. J. Endourol. 2010, 24, 1909–1913. [Google Scholar] [CrossRef]
  58. Gupta, A.; Raman, J.D.; Leveillee, R.J.; Wingo, M.S.; Zeltser, I.S.; Lotan, Y.; Trimmer, C.; Stern, J.M.; Cadeddu, J.A. General anesthesia and contrast-enhanced computed tomography to optimize renal percutaneous radiofrequency ablation: Multi-institutional intermediate-term results. J. Endourol. 2009, 23, 1099–1105. [Google Scholar] [CrossRef]
  59. Ji, C.; Zhao, X.; Zhang, S.; Liu, G.; Li, X.; Zhang, G.; Minervini, A.; Guo, H. Laparoscopic radiofrequency ablation versus partial nephrectomy for cT1a renal tumors: Long-term outcome of 179 patients. Urol. Int. 2016, 96, 345–353. [Google Scholar] [CrossRef]
  60. Klatte, T.; Mauermann, J.; Heinz-Peer, G.; Waldert, M.; Weibl, P.; Klingler, H.C.; Remzi, M. Perioperative, oncologic, and functional outcomes of laparoscopic renal cryoablation and open partial nephrectomy: A matched pair analysis. J. Endourol. 2011, 25, 991–997. [Google Scholar] [CrossRef]
  61. Liu, N.; Huang, D.; Cheng, X.; Chong, Y.; Wang, W.; Gan, W.; Guo, H. Percutaneous radiofrequency ablation for renal cell carcinoma vs. partial nephrectomy: Comparison of long-term oncologic outcomes in both clear cell and non-clear cell of the most common subtype. Urol. Oncol. Semin. Orig. Investig. 2017, 35, 530-e1. [Google Scholar] [CrossRef] [PubMed]
  62. Loloi, J.; Shingleton, W.B.; Nakada, S.Y.; Zagoria, R.J.; Landman, J.; Lee, B.R.; Matin, S.F.; Ahrar, K.; Leveillee, R.J.; Cadeddu, J.A.; et al. Management of Residual or Recurrent Disease Following Thermal Ablation of Renal Cortical Tumors. J. Kidney Cancer VHL 2020, 7, 1–5. [Google Scholar] [CrossRef] [PubMed]
  63. Long, J.-A.; Bernhard, J.-C.; Bigot, P.; Lanchon, C.; Paparel, P.; Rioux-Leclercq, N.; Albiges, L.; Bodin, T.; Nouhaud, F.-X.; Boissier, R.; et al. Partial nephrectomy versus ablative therapy for the treatment of renal tumors in an imperative setting. World J. Urol. 2017, 35, 649–656. [Google Scholar] [CrossRef] [PubMed]
  64. Lorber, G.; Glamore, M.; Doshi, M.; Jorda, M.; Morillo-Burgos, G.; Leveillee, R.J. Long-term oncologic outcomes following radiofrequency ablation with real-time temperature monitoring for T1a renal cell cancer. Urol. Oncol. 2014, 32, 1017–1023. [Google Scholar] [CrossRef]
  65. Matsumoto, E.D.; Johnson, D.B.; Ogan, K.; Trimmer, C.; Sagalowsky, A.; Margulis, V.; Cadeddu, J.A. Short-term efficacy of temperature-based radiofrequency ablation of small renal tumors. Urology 2005, 65, 877–881. [Google Scholar] [CrossRef]
  66. Murray, C.A.; Welch, B.T.; Schmit, G.D.; Schmitz, J.J.; Weisbrod, A.J.; Callstrom, M.R.; Welch, T.L.; Thompson, R.H.; Kurup, A.N.; Boorjian, S.A.; et al. Safety and Efficacy of Percutaneous Image-guided Cryoablation of Completely Endophytic Renal Masses. Urology 2019, 133, 151–156. [Google Scholar] [CrossRef]
  67. Okhunov, Z.; Chamberlin, J.; Moreira, D.M.; George, A.; Babaian, K.; Shah, P.; Youssef, R.; Kaler, K.S.; Lobko, I.I.; Kavoussi, L.; et al. Salvage Percutaneous Cryoablation for Locally Recurrent Renal-Cell Carcinoma After Primary Cryoablation. J. Endourol. 2016, 30, 632–637. [Google Scholar] [CrossRef]
  68. Pandolfo, S.D.; Loizzo, D.; Beksac, A.T.; Derweesh, I.; Celia, A.; Bianchi, L.; Elbich, J.; Costa, G.; Carbonara, U.; Lucarelli, G.; et al. Percutaneous thermal ablation for cT1 renal mass in solitary kidney: A multicenter trifecta comparative analysis versus robot-assisted partial nephrectomy. Eur. J. Surg. Oncol. 2023, 49, 486–490. [Google Scholar] [CrossRef]
  69. Patel, S.R.; Francois, S.; Bhamber, T.; Evans, H.; Gaston, K.; Riggs, S.B.; Teigland, C.; Clark, P.E.; Roy, O.P. Safety and effectiveness of percutaneous renal cryoablation with conscious sedation. Arab. J. Urol. 2020, 18, 163–168. [Google Scholar] [CrossRef]
  70. Psutka, S.P.; Feldman, A.S.; McDougal, W.S.; McGovern, F.J.; Mueller, P.; Gervais, D.A. Long-term oncologic outcomes after radiofrequency ablation for T1 renal cell carcinoma. Eur. Urol. 2013, 63, 486–492. [Google Scholar] [CrossRef]
  71. Rembeyo, G.; Correas, J.M.; Jantzen, R.; Audenet, F.; Dariane, C.; Delavaud, C.; Mejean, A.; Timsit, M.O. Percutaneous Ablation Versus Robotic Partial Nephrectomy in the Treatment of cT1b Renal Tumors: Oncologic and Functional Outcomes of a Propensity Score-weighted Analysis. Clin. Genitourin. Cancer 2020, 18, 138–147. [Google Scholar] [CrossRef] [PubMed]
  72. Stern, J.M.; Svatek, R.; Park, S.; Hermann, M.; Lotan, Y.; Sagalowsky, A.I.; Cadeddu, J.A. Intermediate comparison of partial nephrectomy and radiofrequency ablation for clinical T1a renal tumours. BJU Int. 2007, 100, 287–290. [Google Scholar] [CrossRef] [PubMed]
  73. Sundelin, M.O.; Lagerveld, B.; Ismail, M.; Keeley, F.X., Jr.; Nielsen, T.K. Repeated Cryoablation as Treatment Modality After Failure of Primary Renal Cryoablation: A European Registry for Renal Cryoablation Multinational Analysis. J. Endourol. 2019, 33, 909–913. [Google Scholar] [CrossRef]
  74. Tracy, C.R.; Raman, J.D.; Donnally, C.; Trimmer, C.K.; Cadeddu, J.A. Durable oncologic outcomes after radiofrequency ablation: Experience from treating 243 small renal masses over 7.5 years. Cancer 2010, 116, 3135–3142. [Google Scholar] [CrossRef]
  75. Yanagisawa, T.; Miki, J.; Shimizu, K.; Motohashi, K.; Enoki, K.; Egawa, S. Residue and recurrence in percutaneous cryoablation for cT1 renal tumor: Clinical utility and feasibility of salvage cryoablation with iodized oil marking. Int. J. Urol. 2022, 29, 472–474. [Google Scholar] [CrossRef]
  76. Yang, B.; Autorino, R.; Remer, E.M.; Laydner, H.K.; Hillyer, S.; Altunrende, F.; White, M.A.; Khanna, R.; Stein, R.J.; Haber, G.-P.; et al. Probe ablation as salvage therapy for renal tumors in von Hippel-Lindau patients: The Cleveland Clinic experience with 3 years follow-up. Urol. Oncol. Semin. Orig. Investig. 2013, 31, 686–692. [Google Scholar] [CrossRef]
  77. Zhou, J.; Wu, X.; Zhang, J.; Huang, J.; Chen, Y. Mid-to-long term oncologic and functional outcomes of zero ischemia laparoscopic microwave ablation-assisted tumor enucleation for renal cell carcinoma: A single-center experience. Transl. Cancer Res. 2021, 10, 2328–2336. [Google Scholar] [CrossRef]
  78. Campell, S.C.; Clark, P.E.; Chang, S.S.; Karam, J.A.; Souter, L.; Uzzo, R.G. Renal Mass and Localized Renal Cancer: Evaluation, Management, and Follow-Up: AUA Guideline Part I. J. Urol. 2021, 206, 199. [Google Scholar] [CrossRef]
  79. Sánchez-Martín, F.M.; Millán-Rodríguez, F.; Urdaneta-Pignalosa, G.; Rubio-Briones, J.; Villavicencio-Mavrich, H. Small renal masses: Incidental diagnosis, clinical symptoms, and prognostic factors. Adv. Urol. 2008, 2008, 310694. [Google Scholar] [CrossRef]
  80. Kawamoto, S.; Solomon, S.B.; Bluemke, D.A.; Fishman, E.K. Computed tomography and magnetic resonance imaging appearance of renal neoplasms after radiofrequency ablation and cryoablation. Semin. Ultrasound CT MR 2009, 30, 67–77. [Google Scholar] [CrossRef]
  81. Stewart, S.B.; Thompson, R.H.; Psutka, S.P.; Cheville, J.C.; Lohse, C.M.; Boorjian, S.A.; Leibovich, B.C. Evaluation of the National Comprehensive Cancer Network and American Urological Association renal cell carcinoma surveillance guidelines. J. Clin. Oncol. 2014, 32, 4059–4065. [Google Scholar] [CrossRef] [PubMed]
  82. Iannuccilli, J.D.; Grand, D.J.; Dupuy, D.E.; Mayo-Smith, W.W. Percutaneous ablation for small renal masses-imaging follow-up. Semin. Interv. Radiol. 2014, 31, 50–63. [Google Scholar] [CrossRef]
  83. Javadi, S.; Ahrar, J.U.; Ninan, E.; Gupta, S.; Matin, S.F.; Ahrar, K. Characterization of contrast enhancement in the ablation zone immediately after radiofrequency ablation of renal tumors. J. Vasc. Interv. Radiol. 2010, 21, 690–695. [Google Scholar] [CrossRef] [PubMed]
  84. Breda, A.; Anterasian, C.; Belldegrun, A. Management and outcomes of tumor recurrence after focal ablation renal therapy. J. Endourol. 2010, 24, 749–752. [Google Scholar] [CrossRef]
Cancers 17 00974 g001
Figure 1. Flow chart of preferred reporting items for systematic reviews and meta-analyses (PRISMA).
Figure 1. Flow chart of preferred reporting items for systematic reviews and meta-analyses (PRISMA).
Cancers 17 00974 g001
Table 2. Primary ablative therapy approaches for management of small renal mass in 364 patients who experienced recurrence during follow-up period.
Table 2. Primary ablative therapy approaches for management of small renal mass in 364 patients who experienced recurrence during follow-up period.
Primary Ablation ApproachNumber (%) of Patients
CA198 (54.3%)
RFA123 (33.7%)
HIFU19 (5%)
MVA2 (0.5%)
Not specified23 (6%)
Total364
CA: cryoablation; RFA: radiofrequency ablation; MWA: microwave ablation; HIFU: high-intensity focused ultrasound.
Table 3. Secondary treatment modalities for management of failures after primary ablation of small renal mass in 364 patients. CA: cryoablation; RFA: radiofrequency ablation.
Table 3. Secondary treatment modalities for management of failures after primary ablation of small renal mass in 364 patients. CA: cryoablation; RFA: radiofrequency ablation.
Secondary TreatmentNumber (%) of Cases
Re-ablation249 (68.4%)RFA: 37 (14.9%)
CA: 138 (55.4%)
Not Specified: 74 (29.7%)
Laparoscopic/Robotic Partial or Radical Nephrectomy82 (22.5%)Partial Nephrectomy: 46 (56.1%)
Radical Nephrectomy: 36 (43.9%)
Active Surveillance33 (9%)
Total364
Table 4. Outcomes of various secondary treatment modalities for management of tumor recurrence after primary ablation (n = 364).
Table 4. Outcomes of various secondary treatment modalities for management of tumor recurrence after primary ablation (n = 364).
Re-Ablation n = 249
RFANED: 33
Recurrence: 4
CANED: 89
Recurrence: 46
Unknown: 3
Not specifiedNED: 57
Recurrence: 17
Total NED: 179 (71.9%)
Recurrence: 67 (26.9%)
Unknown: 3
Laparoscopic/robotic partial or radical nephrectomy n = 82
Robotic partial nephrectomy (n = 46)NED:40
Unknown: 6
Robotic/laparoscopic radical nephrectomy (n = 36)NED:23
Recurrence: 1
Unknown: 12
Total NED: 63
Recurrence: 1
Unknown: 18
Active surveillance n = 33
SurveillanceSurgery: 4
Death: 4
Surveillance: 25
NED: No evidence of disease; CA: cryoablation; RFA: radiofrequency ablation.
Disclaimer/Publisher’s Note: The statements, opinions and data contained in all publications are solely those of the individual author(s) and contributor(s) and not of MDPI and/or the editor(s). MDPI and/or the editor(s) disclaim responsibility for any injury to people or property resulting from any ideas, methods, instructions or products referred to in the content.

Share and Cite

MDPI and ACS Style

Askarpour, M.; Aminsharifi, A. Minimally Invasive Salvage Approaches for Management of Recurrence After Primary Renal Mass Ablation. Cancers 2025, 17, 974. https://doi.org/10.3390/cancers17060974

AMA Style

Askarpour M, Aminsharifi A. Minimally Invasive Salvage Approaches for Management of Recurrence After Primary Renal Mass Ablation. Cancers. 2025; 17(6):974. https://doi.org/10.3390/cancers17060974

Chicago/Turabian Style

Askarpour, Mohammadreza, and Alireza Aminsharifi. 2025. "Minimally Invasive Salvage Approaches for Management of Recurrence After Primary Renal Mass Ablation" Cancers 17, no. 6: 974. https://doi.org/10.3390/cancers17060974

APA Style

Askarpour, M., & Aminsharifi, A. (2025). Minimally Invasive Salvage Approaches for Management of Recurrence After Primary Renal Mass Ablation. Cancers, 17(6), 974. https://doi.org/10.3390/cancers17060974

Note that from the first issue of 2016, this journal uses article numbers instead of page numbers. See further details here.

Article Metrics

Back to TopTop