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Oncologic and Safety Outcomes of Microwave Ablation Versus Partial Nephrectomy for Small Renal Masses: Systematic Review and Meta-Analysis
Thaise Sestelo Uzeda, MD1, Giulia Almiron da R. Soares, MD2, Phillip Anderson da Silva Avelino, BS3, Murilo Ribeiro Sanches, MD4, Heidi J. Rayala, MD, PhD1, Barbara Viera Lima Aguiar Melão, MD, PhD5.
1Beth Israel Deaconess Medical Center, Boston, MA, USA, 2Metropolitan University of Santos, Santos, Brazil, 3Federal University of Rio Grande do Norte, Natal, Brazil, 4Federal University of Goias, Goiania, Brazil, 5University of São Paulo, São Paulo, Brazil.
BACKGROUND: Partial nephrectomy (PN) remains the standard treatment for localized renal tumors, while microwave ablation (MWA) offers a minimally invasive nephron-sparing alternative. This meta-analysis compared oncologic and safety outcomes between both techniques.
METHODS: Nine comparative studies (2,827 patients; 866 MWA, 1,961 PN) were included. Data on local recurrence, complications, distant metastasis, and overall survival were extracted. Random-effects models were used to calculate odds ratios (OR)
with 95% confidence intervals. Studies with zero events in both groups were described but excluded from log-OR analyses. Sensitivity analyses employed minimal event substitution to test robustness.
RESULTS: Mean age was 63.2 years (MWA) and 61.7 years (PN); 57.3% and 59.1% were male, respectively. Among 1,240 patients, MWA showed a higher risk of local recurrence compared to PN (OR=1.81). Heterogeneity was minimal (I
2=0%). Under the fixed-effect model, the association reached statistical significance (OR=1.90). MWA significantly reduced odds of complication (OR=0.56). No significant difference was found for distant metastasis (OR=1.06; adjusted=1.05). Overall survival analysis also revealed no difference between the groups (OR=0.99; adjusted=0.97). Across all endpoints, the direction and magnitude of effects remained stable in sensitivity analyses, confirming the robustness of findings.
CONCLUSIONS: In this pooled analysis, MWA achieved comparable oncologic results to PN while lowering complication rates. The borderline increase in local recurrence highlights the need for longer follow-up and randomized evidence, but current data support MWA as a safe, effective, and minimally invasive nephron-sparing option for selected patients with small renal masses.
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