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

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 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.