Marlin A A Reijerink, Luna van den Brink, Michaël M.E.L. Henderickx, Otto M. van Delden, Harrie P. Beerlage, Axel Bex, Faridi Jamaludin, Mitra Nekouei Shahraki, Patricia Zondervan, Jaap Stoker
OBJECTIVE: This systematic review aims to assess whether studies that followed the 2016 and updated 2024 European Association of Urology (EAU) Renal Cell Carcinoma (RCC) guidelines for CT during follow-up after tumor ablation (TA) yield different oncological outcomes compared to studies that performed more frequent imaging. MATERIALS AND METHODS: A literature search of relevant search engines was performed up to June 6th, 2025. Studies that reported follow-up schedules of patients after TA for cT1 RCC were included. Studies utilizing more CT scans than recommended by the 2016 and 2024 EAU guidelines were compared with those adhering to the guidelines. Data on recurrences and survival were analyzed. RESULTS: Thirty-seven studies met the inclusion criteria, involving patients with cT1 RCC treated with TA. The mean 5-year overall survival rate was 82.9%. The pooled recurrence rate was 7.7% in studies that performed more imaging than recommended by the 2016 EAU guideline, compared with 12.3% in studies that adhered to the guideline (p = 0.19). All studies performed more imaging than recommended by the updated 2024 guidelines. Risk of bias was moderate to high in most studies. CONCLUSION: The majority of included studies conducted more frequent imaging than advised by the 2016 EAU guidelines, with all studies exceeding the 2024 EAU guidelines. The studies included in our systematic review revealed similar oncological outcomes after TA, among studies that followed the 2016 EAU guidelines and those that performed more frequent imaging, suggesting that more frequent imaging than the 2016 EAU guidelines may not lead to a survival benefit. KEY POINTS: Question Does more frequent follow-up CT imaging after tumor ablation for localized renal cell carcinoma improve oncological outcomes compared to European Association of Urology guideline recommendations? Findings 89% of studies performed more frequent CT scans than the 2016 guidelines; recurrence was 7.7% with extra scans versus 12.3% with guideline adherence. Clinical relevance Current intensive imaging protocols may not improve patient outcomes, supporting potential reduction in follow-up imaging frequency to minimize radiation exposure and healthcare costs while maintaining adequate oncological surveillance.