Ablative Therapies for Early Stage Kidney Cancer and the Evolving Role of the Urologist

Introduction The modern treatment paradigms for early stage kidney cancer include ablative therapies. Unlike surgical ablation, percutaneous ablation uses a radiographic platform, potentially altering the role of the urologist. We compared surgical and percutaneous ablation regarding treatment processes and outcomes. Methods Using SEER (Surveillance, Epidemiology and End Results)-Medicare data, we identified subjects undergoing surgical or percutaneous ablation between 2006 and 2009 for stage I kidney cancer. We evaluated outcomes relating to 30-day complications, unplanned hospital admissions, long-term survival and mortality. Adjusting for patient characteristics, we compared processes and outcomes according to ablation approach using generalized estimating equations and Cox proportional hazard models, respectively. Results We identified 376 subjects (45.8%) treated with surgical ablation and 444 (54.1%) treated with percutaneous ablation. Use of percutaneous ablation increased substantially during the study period. Compared to surgical ablation, percutaneous ablation was applied more often in the outpatient setting (71.2% vs 2.4%, p <0.001) and following a period of surveillance (14.6% vs 6.1%, p <0.001). Subjects treated with percutaneous ablation were less likely to have preoperative, perioperative or postoperative urological involvement (p <0.001). While adverse events were more common for surgical ablation (32.7% vs 15.0%, p <0.001), unplanned hospitalizations were similar (10.2% vs 9.1%, p = 0.625), as was 30-day mortality (2.6% vs 1.1%, p = 0.127). Retreatment-free survival was significantly higher for surgical vs percutaneous ablation (HR 1.84, 95% CI 1.15–2.94). Conclusions Percutaneous ablation has become the most common ablative modality for early stage kidney cancer. Although percutaneous ablation carries a more favorable safety profile, posttreatment morbidity occurs with some frequency, highlighting the need for continued urologist engagement.