Background: The incidence of small (<4 cm) solid enhancing renal masses has been rising, and the majority (60% to 80%) of these tumors are renal cell carcinomas (RCCs) when pathologic analysis is performed. Needle ablation for small incidental renal masses is an attractive therapeutic option. Reasons include its decreased morbidity, shorter convalescence, and the ability to avert the higher risk of extirpative surgery in an aging patient population. Radiofrequency ablation (RFA) is a thoroughly studied needle ablative method used for RCC. Methods: The current published literature on renal tumor RFA was reviewed. The in vitro experiments, animal studies and clinical experience with RFA for treatment of small RCCs were analyzed and various controversies in renal RFA are presented for discussion. Results: Percutaneous and laparoscopic renal RFA can be safely performed and can eradicate small RCCs with cancer specific survival rates over 90% to 95% in many series. While long-term (5 years or greater) cancer control data are not yet available, these intermediate-term results are similar to those achieved with traditional nephron-sparing surgical options. However, the optimal method to perform RFA for renal masses is still evolving. Conclusions: While long-term cancer control data are not yet available, the current literature suggests that RFA can effectively eradicate small RCCs. Further research is needed to elucidate the influence of various treatment variables, including impedance vs temperature-controlled RFA, sonographic vs computed tomographic guidance, general anesthetic vs conscious sedation, and radiologist vs urologist delivery of renal RFA.
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