A prospective study on ablative therapy for small renal masses (SRM) at a tertiary care centre in Sri Lanka

Introduction: Renal cell carcinoma (RCC) is the fourteenth most common malignancy. Improved cross-sectional imaging has increased the identification of small renal masses (SRMs), resulting in a change in care to nephron sparing techniques such as microwave ablation (MWA). This study evaluated the patient characteristics, tumor features, and early outcomes of image-guided MWA for SRMs in a tertiary care environment in Sri Lanka.
Methodology: This prospective observational study was carried out in a tertiary care hospital between April 2023 and May 2024. Consecutive patients with biopsy—proven T1a SRMs (≤4 cm) who underwent curative percutaneous MWA following multidisciplinary team (MDT) evaluation, were included. Clinical, radiological, histological, and renal function data were obtained. The outcomes included technical success, complications, recurrence, and changes in renal function.
Results: Twelve patients (mean age 52.1 ±13.19 years; 83.33% male) underwent MWA with a mean follow-up of 28.63 months until April 2026. Hypertension was the most common comorbidity, and 75% of lesions were incidentally detected. Clear cell RCC was the most common histological subtype (66.67%), followed by oncocytoma (16.67%). Technical success was achieved in all cases, with 83.33% required a single ablation session. Only two minor complications (16.67%) (Clavien-Dindo grades I and II) were recorded. Renal function was preserved, with no evidence of local ecurrence or distant metastasis during follow-up.
Conclusion: Image-guided MWA revealed great technical success, acceptable safety, and effective short-term oncological management while maintaining renal function, indicating that it is a potential nephron-sparing alternative for selected SRMs in resource-limited settings.