Percutaneous thermal ablation for renal cell carcinoma: a comprehensive review of current evidence and future directions.

Thermal ablation (TA), including microwave ablation, radiofrequency ablation, and cryoablation, is increasingly used as a surgical alternative for T1a renal cell carcinoma (RCC), particularly in lesions measuring ≤ 3 cm. In this review, we aimed to summarize current evidence on the efficacy, safety, and long-term outcomes of TA in RCC and to explore future directions in this evolving field. A comprehensive review of the literature was conducted, focusing on the indications for TA, considering tumor size and location, patient age, and comorbidity status (assessed using Charlson Comorbidity Index). Recent studies have reported favorable long-term outcomes of TA for RCC with follow-up exceeding 10 years. Among the different TA modalities, no significant differences in therapeutic efficacy or safety were observed, particularly for tumors measuring ≤ 3 cm. Compared to partial nephrectomy, the standard treatment for small renal tumors, TA offers advantages in preserving renal function and reducing the risk of complications; however, it is associated with a higher local recurrence rate. Nevertheless, favorable cancer-specific survival rates comparable to those with surgical resection have been achieved with additional TA for local residual tumors. Adjunctive techniques, including preprocedural transarterial embolization and hydrodissection, may further improve the safety and efficacy of TA. In the future, introducing advanced technologies, including robotic systems and artificial intelligence, is expected to further enhance TA's safety and efficacy in RCC management.