Abstract
To describe the safety, technical results, and clinical outcomes of percutaneous cryoablation of stage T1b renal cell carcinoma (RCC). A retrospective review of the radiology information system was performed to identify 36 adult patients with 36 RCC lesions measuring 4.1-7.0 cm who underwent percutaneous cryoablation from 2004-2018. Patient demographics, co-morbidities, tumor characteristics, technical parameters of the procedure, technical outcomes, complications, and local recurrence rates were recorded. Cancer-specific survival rates were estimated using the Kaplan-Meier method. A multi-variate analysis was performed to identify any potential predictors of complications, local recurrence, or survival. Mean tumor diameter was 4.9 cm (±1.2), with a median of 3 probes (range:1-7) used. Prophylactic embolization was performed in 4 patients (11.1%) and hydrodissection was needed in 1 patient (2.8%). The median number of procedures required to achieve local control was one (mean: 1.5, range: 1-4). Minor complications not requiring therapy occurred in 15 patients (41.7%) including: hematoma (n=10), hematuria (n=3), abscess (n=1), and arteriovenous fistula (n=1). Two major complications (5.6%) included one abscess and an incidence of acute renal failure, both which were appropriately managed without long-term sequelae. No significant change in glomerular filtration rate was seen after ablation (p=0.95). Seven patients (19.4%) had local recurrence, which occurred at a mean of 26.7 months (range: 4.3-52.2). Cancer-specific survivals were 100%, 100%, 100%, and 71.4% at 1, 2, 3, and 5 years, respectively. On multi-variate analysis, endophytic tumors (p=0.003) and nearness to the collecting system (p=0.006) were independent predictors of complications. None of the evaluated variables were able to independently predict local recurrence or cancer-specific survival. Percutaneous cryoablation is a viable therapeutic option for stage T1b RCC with an overall low rate of major complications.
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