AUTHOR'S REPLY.

We agree with the comments by Laguna [1] and Cumpanas [2]. While our manuscript [3] focused on radiographic tumor features as criteria for percutaneous ablation, the choice to ablate or undergo surgical resection is also driven by patient characteristics. For poor surgical candidates, ablation remains an option, however it has been shown to have inferior oncologic outcomes compared to extirpative management [4]. For this population, active surveillance may achieve similar oncologic outcomes without the need for surgical management. Our group recently showed that in carefully selected patients, oncologic outcomes are equivalent between active surveillance and intervention [5].

The management of small renal masses highlights the need for individualized consideration of tumor characteristics in the context of patient characteristics and preferences. Active surveillance is emerging as a safe and reliable option for patients who do not desire or cannot tolerate immediate extirpative management, but who are seeking oncologic control similar to that of partial or radical nephrectomy.