Laparoscopic Partial Nephrectomy Versus Microwave Ablation in the Treatment of Renal Masses

BACKGROUND: Nephron-sparing surgery is standard for localised renal cell carcinoma, while microwave ablation (MWA) is increasingly used in older and comorbid patients. Comparative data on local recurrence between laparoscopic partial nephrectomy (LPN) and MWA remain inconsistent. We aimed to compare local recurrence rates and identify patient and tumour factors favouring either modality. METHODS: A 5-year retrospective study was conducted at a regional centre in Queensland, Australia. The study included 158 adults with localised renal cancer treated with curative intent using LPN or MWA. It excluded metastatic disease, palliative treatment or alternative focal therapies. Demographics, tumour and renal function data were analysed. Statistical analyses were performed using R version 4.4.1, with significance set at p < 0.05. RESULTS: MWA was associated with significantly higher odds of local recurrence compared with LPN (OR 5.73, 95% CI 1.51-37.5, p = 0.02). A Charlson Comorbidity Index > 5 showed a trend towards higher odds of recurrence (OR 3.26, 95% CI 1.06-12.2, p = 0.05), as did age > 65 years (OR 4.31, 95% CI 1.13-28.2, p = 0.06). Patients undergoing MWA were significantly older, more comorbid and more likely to have tumours < 4 cm. The change in creatinine level was significantly higher post-LPN. Salvage therapy achieved local tumour control in 60% of cases at a mean follow-up of 21.4 months. CONCLUSION: MWA demonstrated higher local recurrence rates than LPN but was predominantly used in older, comorbid patients and provided superior nephron preservation. MWA remains an effective primary and salvage treatment option in appropriately selected patients.