Is radiofrequency ablation more cost-effective than nephron-sparing surgery for small unilateral renal cell carcinoma?

A recent report suggesting significant cost-effectiveness advantage for renal radiofrequency ablation (RFA) over partial nephrectomy makes assumptions about rates of local cancer recurrence, estimates of which are inexact at this point in time. Uncertainty regarding the oncologic efficacy of RFA technology and the expense and challenges of adequate post-treatment surveillance further confound this comparison. Partial nephrectomy remains the standard of care for nephron-sparing surgery, and should remain the preferred treatment in patients with an acceptable risk profile. Until longer-term follow-up data are available, RFA should be reserved for elderly patients and those with multiple comorbidities who have only a small renal mass.