Pre-cryoablation Embolization of Renal Tumors: Decreasing Probes and Saving Loads.

Taylor S Harmon,Joanna Kee-Sampson,Jerry Matteo,Travis E Meyer

doi:10.7759/cureus.3676

Abstract

The use of adjuvant pre-ablation embolization for renal tumors has been reported in endophytic, centrally located lesions to reduce the risk of injuring the renal collecting system during subsequent cryoablation. In this technical report, we present another utilization of adjuvant pre-ablation embolization, applied for the purpose of decreasing the number of cryoablation probes needed in the ablation intervention. This novel procedural protocol not only decreases the cost of the procedure, but also preserves more normal renal parenchyma, and decreases the risk of injuries related to probe positioning.

Highlights

Surgical and percutaneous interventional management of renal cell carcinomas has been on the rise, in parallel to the incidental discovery of these tumors from an increase in utilization of cross-sectional imaging [1]
Matteo et al described the use of pre-ablation embolization to reduce the risk of injuring the renal collecting system and surrounding parenchyma when performing cryoablation on endophytic, centrally located tumors [4]
Low incidence of residual or recurrent tumors has been reported for renal lesions treated with cryoablation; in a prospective study of 616 patients treated with cryoablation or radiofrequency ablation (RFA), the tumors treated with cryoablation had a lower incidence of residual or recurrent tumors (3.9%) compared with RFA (13.4%) [9]

Summary

Introduction

Surgical and percutaneous interventional management of renal cell carcinomas has been on the rise, in parallel to the incidental discovery of these tumors from an increase in utilization of cross-sectional imaging [1]. Matteo et al described the use of pre-ablation embolization to reduce the risk of injuring the renal collecting system and surrounding parenchyma when performing cryoablation on endophytic, centrally located tumors [4]. This novel, two-step approach was shown to cause tumor shrinkage, allowing safe and effective percutaneous cryoablation of the lesions [4]. Due to the concern for renal collecting system injury as a result of the endophytic tumor morphology and excessive injury to the normal renal parenchyma with the number of probes needed to treat the lesion, a preablation embolization was performed in an attempt to shrink the lesion prior to cryoablation. Axial (A) and coronal (B) images show no residual malignancy four months after cryoablation

Discussion

Conclusions

Disclosures

Findings

Maybody M