Cryoablation Of Renal Masses Research Articles

Quadratus lumborum block for procedural and postprocedural analgesia in renal cell carcinoma percutaneous cryoablation.

This study assesses the efficacy of the quadratus lumborum block (QLB) in the management of procedural and periprocedural pain associated with small renal mass cryoablation. To the best of our knowledge, this is the first study that examines the use of QLB for pain management during percutaneous cryoablation of renal cell carcinoma (RCC). A single-center retrospective review was conducted for patients who underwent cryoablation for RCC with QLB between October 2020 and October 2021. The primary study endpoint included a total dose of procedural conscious sedation and administered, postprocedural analgesia. Technical success in cryoablation was achieved in every case. No patients required additional analgesic during or after the procedure, and no complications resulted from the use of the QLB. The QLB procedure appears to be an effective locoregional block for the management of procedural and periprocedural pain associated with renal mass cryoablation.

Percutaneous Microwave Ablation versus Cryoablation for Small Renal Masses (≤4 cm): 12-Year Experience at a Single Center

PurposeTo determine whether microwave ablation (MWA) has equivalent outcomes to those of cryoablation (CA) in terms of technical success, adverse events, local tumor recurrence, and survival in adult patients with solid enhancing renal masses ≤4 cm. Materials and MethodsA retrospective review was performed of 279 small renal masses (≤4 cm) in 257 patients (median age, 71 years; range, 40–92 years) treated with either CA (n = 191) or MWA (n = 88) between January 2008 and December 2020 at a single high-volume institution. Evaluations of adverse events, treatment effectiveness, and therapeutic outcomes were conducted for both MWA and CA. Disease-free, metastatic-free, and cancer-specific survival rates were tabulated. The estimated glomerular filtration rate was employed to examine treatment-related alterations in renal function. ResultsNo difference in patient age (P = .99) or sex (P = .06) was observed between the MWA and CA groups. Cryoablated lesions were larger (P < .01) and of greater complexity (P = .03). The technical success rate for MWA was 100%, whereas 1 of 191 cryoablated lesions required retreatment for residual tumor. There was no impact on renal function after CA (P = .76) or MWA (P = .49). Secondary analysis using propensity score matching demonstrated no significant differences in local recurrence rates (P = .39), adverse event rates (P = .20), cancer-free survival (P = .76), or overall survival (P = .19) when comparing matched cohorts of patients who underwent MWA and CA. ConclusionsHigh technical success and local disease control were achieved for both MWA and CA. Cancer-specific survival was equivalent. Higher adverse event rates after CA may reflect the tendency to treat larger, more complex lesions with CA.

Oncological and Peri-Operative Outcomes of Percutaneous Cryoablation of Renal Cell Carcinoma for Patients with Hereditary RCC Diseases-An Analysis of European Multi-Centre Prospective EuRECA Registry.

This study aims to evaluate the safety, efficacy, and renal function preservation of percutaneous cryoablation (PCA) for small renal masses (SRMs) in inherited RCC syndromes. Patients with inherited T1N0M0 RCCs (<7 cm) undergoing PCA from 2015 to 2021 were identified from the European Registry for Renal Cryoablation (EuRECA). The primary outcome was local recurrence-free survival (LRFS). The secondary outcomes included technical success, peri-operative outcomes, and other oncological outcomes estimated using the Kaplan-Meier method. Simple proportions, chi-squared tests, and t-tests were used to analyse the peri-operative outcomes. A total of 68 sessions of PCA were performed in 53 patients with RCC and 85 tumours were followed-up for a mean duration of 30.4 months (SD ± 22.0). The overall technical success rate was 99%. The major post-operative complication rate was 1.7%. In total, 7.4% (2/27) of patients had >25% reduction in renal function. All oncological events were observed in VHL patients. Estimated 5-year LRFS, metastasis-free survival, cancer-specific survival, and overall survival were 96.0% (95% CI 75-99%), 96.4% (95% CI 77-99%), 90.9% (95% CI 51-99%), and 90.9% (95% CI 51-99%), respectively. PCA of RCCs for patients with hereditary RCC SRMs appears to be safe, offers low complication rates, preserves renal function, and achieves good oncological outcomes.

MP47-18 OUTCOMES OF PERCUTANEOUS RENAL CRYOABLATION IN A LARGE COHORT OVER 15 YEARS

You have accessJournal of UrologyCME1 Apr 2023MP47-18 OUTCOMES OF PERCUTANEOUS RENAL CRYOABLATION IN A LARGE COHORT OVER 15 YEARS Zachary A. Valley, Evan Allarie, Steven Lu, Richard Cormack, Michael Welsh, Bryan J. Donnelly, and Kamaljot S. Kaler Zachary A. ValleyZachary A. Valley More articles by this author , Evan AllarieEvan Allarie More articles by this author , Steven LuSteven Lu More articles by this author , Richard CormackRichard Cormack More articles by this author , Michael WelshMichael Welsh More articles by this author , Bryan J. DonnellyBryan J. Donnelly More articles by this author , and Kamaljot S. KalerKamaljot S. Kaler More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003293.18AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Historically, the standard of care for renal cell carcinoma (RCC) has been partial nephrectomy (PN) or radical nephrectomy (RN). Image-guided percutaneous cryoablation (PCA) of renal masses has emerged as a nephron-sparing, minimally invasive alternative. In this study, we aim to assess outcomes of percutaneous renal cryoablation at a single centre over 15 years. METHODS: Patients who underwent PCA of renal masses from 2006 to 2022 were included with no exclusions. All patients had cross-sectional imaging prior to the procedure and most underwent biopsy at the time of procedure. Cryoprobe placement and ice-ball formation was monitored via computed tomography (CT) imaging during the procedure. Data were collected via electronic medical record review, as well as pre-, intra-, and post-procedure imaging review. Data included demographics, tumor characteristics, pathology, local recurrence and metastatic disease rates, complications, pre- and post-procedure renal function and blood counts, co-morbidities, and mortality rate of patients in follow-up. RESULTS: This study included 598 patients in the analysis with a median age of 65.1 years and median follow-up of 39 months (Table 1). The average size of tumor was 2.7 cm. Overall local recurrence rate was 4.8% including surgically resected and hereditary RCC. Average nephrometry score was 6.1. Median time to local recurrence was 2.0 years. Five percent of patients made up 52% of the recurrences. Overall survival rate was 82.3% at time of analysis. Cancer-specific survival overall was 97.3%. Average length of time to discharge was 28.2 hours. The Clavien-Dindo 3+ complication rate was 2.3%. Overall metastatic rate was 1.8% and 0.7% in patients with no recurrence. CONCLUSIONS: PCA outcomes in this large cohort with no exclusions and long-term follow-up revealed an overall low recurrence rate, low complication rate, and an acceptable metastatic rate. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e651 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Zachary A. Valley More articles by this author Evan Allarie More articles by this author Steven Lu More articles by this author Richard Cormack More articles by this author Michael Welsh More articles by this author Bryan J. Donnelly More articles by this author Kamaljot S. Kaler More articles by this author Expand All Advertisement PDF downloadLoading ...

Abstract No. 170 Bleeding Complications Requiring Therapeutic Trans-Arterial Embolization Following Percutaneous Cryoablation for cT1b and cT2 Renal Masses without and with Pre-ablation Prophylactic Trans-Arterial Embolization

Abstract No. 170 Bleeding Complications Requiring Therapeutic Trans-Arterial Embolization Following Percutaneous Cryoablation for cT1b and cT2 Renal Masses without and with Pre-ablation Prophylactic Trans-Arterial Embolization

Cryoablation of small renal masses in patients with solitary kidneys: worth crossing the road for?

Cryoablation of small renal masses in patients with solitary kidneys: worth crossing the road for?

Percutaneous Microwave Ablation is Comparable to Cryoablation for the Treatment of T1a Renal Masses: Results From a Cross-Sectional Study.

Percutaneous microwave ablation (MWA) of renal masses (RM) is still considered experimental as opposed to established procedures such as cryoablation (CA). We aimed to compare perioperative, functional and oncological outcomes of patients with RM treated with CA and MWA. Data from 116 (69.9%) and 50 (30.1%) patients treated with CA and MWA for RM were analyzed. Patients' demographics and perioperative data were collected including nephrometry scores, complications, pre- and postprocedural renal function. Tumor persistence and recurrence were recorded. Descriptive statistics compared functional outcomes between groups. Cox regression analyses tested risk factors associated with recurrence. Groups were similar in terms of RM diameter, nephrometry scores and histology distribution. Median follow-up was 26 (13-46) and 24 (14-36) months for CA and MWA, respectively. The rate of overall (36.2% for CA vs. 24% for MWA, P= .1) and major (Clavien ≥ 3a) complications (1.7% vs. 5.4%, P=.1) were similar among groups. The median decline of renal function after 6 months follow-up did not differ between CA and MWA (P=.8). Tumor persistence [4.3% vs. 12%] and recurrence [9.5% and 7.1%] rates were similar for CA and MWA. Three years recurrence free and overall survival were 91% versus 95% (log-rank P=.77) and 80 versus 88% (log-rank P=.23) in the CA and MWA groups, respectively. At Cox analysis no predictors were found associated with recurrence. Despite being considered still experimental, MWA showed comparable outcomes relative to CA in terms of safety, preservation of renal function and oncological efficacy.

Outcomes of cryoablation for small renal masses: a single-institution study

Background: The current study reports the clinical outcomes of the efficacy of computerized tomography (CT) guided cryoablation (CA) in the treatment of patients with small renal masses.Methods: This retrospective single institution study analyses the clinical outcomes of 36 renal tumours that were managed with cryoablation. Patient age, sex, tumour size, complications and recurrences were recorded. These patients were followed up at 3,6- and 12-months interval, they underwent biopsy and abdominal contrast enhanced ultrasound (CEUS) depending upon indications.Results: 36 patients (63.9% male, 19.4% female) each with a single small renal mass had CA with a follow-up at 3, 6 and 12 months. The mean tumour size was 606.9±31.8 mm2. Eleven complications occurred in 36 patients, for an overall complication rate of 30.6%. One (2.7%) patient had enhancement at the surgical bed on initial imaging and were considered incomplete ablations. None of the patients showed signs of distant metastases at the 3, 6 and 12-month follow-ups.Conclusions: Cryoablation of renal masses results in acceptable oncologic efficacy with an acceptable number of complications. Therefore, it remains a viable treatment for renal masses.

P105 - 3D virtual models for planning percutaneous Cryoablation of small renal masses

P105 - 3D virtual models for planning percutaneous Cryoablation of small renal masses

Safety and Effectiveness of Transhepatic Access for Percutaneous Renal Mass Cryoablation: A Multicenter Cohort

PurposeTo establish transhepatic percutaneous cryoablation of renal masses as a safe and effective approach. Materials and MethodsA retrospective review of records from 3 separate medical centers was performed identifying 23 patients (median age, 63 years [range 41–84 years]; 12 female [52.2%]) who underwent percutaneous transhepatic cryoablation for right-sided renal masses (median diameter, 2.4 cm [1.5–4.6 cm]) between 2008 and 2021. The median radius, exophytic/endophytic, nearness to collecting system or sinus, anterior/posterior, and location relative to polar lines (RENAL) nephrometry score was 5 (4–10). Adverse events (AEs) were classified according to the Society of Interventional Radiology (SIR) and Clavien-Dindo (CD) classifications. Primary and secondary technical success of each procedure were recorded. ResultsRenal cell carcinoma (of any subtype) was found in 10 (71.5%) of the 14 masses that were biopsied. Tract cautery was used for transhepatic probes in 14 (63.6%) of 22 procedures. Three (13%) of 23 patients had postprocedural AEs. Two cases (8.6%) were hemorrhages related to transhepatic access (SIR moderate-2, CD 2; SIR severe-3, CD 1), and 1 case (4.4%) was related to bowel injury (SIR severe-3, CD 3a). There were no instances of pneumothorax. Tract cautery was used in the procedures that resulted in an AE. Primary technical success was achieved in 84.2% (16/19) of procedures, whereas secondary technical success was achieved in 2 additional patients. The secondary technical success rate was 94.7% (18/19). Four patients did not have imaging follow-up. ConclusionsThe transhepatic approach to cryoablation of renal masses appears to have an acceptable safety profile and technical success rate. Larger studies, preferably comparative to nontranshepatic approach, are recommended.

Assessing Trifecta Achievement after Percutaneous Cryoablation of Small Renal Masses: Results from a Multi-Institutional Collaboration.

Background and Objectives: To assess efficacy and safety of Percutaneous Cryoablation (PCA) of small renal masses (SRMs) using Trifecta outcomes in a large cohort of patients who were not eligible for surgery. Materials and methods: All PCAs performed in four different centers between September 2009 and September 2019 were retrospectively evaluated. Patients were divided in two different groups depending on masses dimensional criteria: Group-A: diameter ≤ 25 mm and Group-B: diameter > 25 mm. Complications rates were reported and classified according to the Clavien–Dindo system. The estimate glomerular filtration rate (eGFR) was calculated before PCA and during follow-up schedule. Every patient received a Contrast Enhanced Ultrasound (CEUS) evaluation on the first postoperative day. Radiological follow-up was taken at 3, 6, and 12 months for the first year, then yearly. Radiological recurrence was defined as a contrast enhancement persistence and was reported in the study. Finally, Trifecta outcome, which included complications, RFS, and preservation of eGFR class, was calculated for every procedure at a median follow-up of 32 months. Results: The median age of the patients was 74 years. Group-A included 200 procedures while Group-B included 140. Seventy-eight patients were eligible for Trifecta evaluation. Trifecta was achieved in 69.6% of procedures in Group-A, 40.6% in Group-B (p = 0.02). We observed an increased rate of complication in Group-B (13.0% vs. 28.6; p < 0.001). However, 97.5% were <II Clavien–Dindo grade. No differences were found between the two groups regarding eGFR before and after treatment. Further, 24-months RFS rates were respectively 98.0% for Group-A and 92.1% in Group-B, while at 36 months were respectively 94.5% and 87.5% (p = 0.08). Conclusions: PCA seems to be a safe and effective treatment for SRM but in the need of more strict dimensional criteria to achieve a higher possible success rate.

V6 - Cryoablation of small renal masses – preliminary first year experience

V6 - Cryoablation of small renal masses – preliminary first year experience

UP08 - Cryoablation for small renal masses: 15 years of experience at a tertiary referral center

UP08 - Cryoablation for small renal masses: 15 years of experience at a tertiary referral center

Percutaneous cryoablation for high-complexity renal masses: complications, functional and oncological outcomes.

During the past two decades cryoablation (CA) has become a therapeutic option for the management of localized cT1 renal masses in comorbid patients. We analyzed the mid-term functional and oncological outcomes of CA in the treatment of cT1 renal masses which were classified as high-complexity masses according to the PADUA system. A total of 299 patients underwent percutaneous CA between November 2007 and December 2018 in 4 institutions for cT1N0M0 renal masses. All patients with high-complexity (PADUA≥10) renal tumors were included. Technical failure of CA was considered an exclusion criterion. Inclusion criteria were met by 45 patients. Median Charlson Comorbidity Index (CCI) was 6.0 (IQR: 5.0-7.0), median age was 74 years (IQR: 64.5-79.5). Seven Clavien 1 and 1 Clavien 2 procedure-related complications were reported. Median eGFR at baseline was 64.3mL/min (IQR: 52.0-82.3) while at the 1-year follow-up was 61.4 mL/min (IQR: 44.0-74.5). The median follow-up was 32 months (IQR: 13.25-47.5). Local recurrences were detected in 6 patients; 3 of them underwent re-cryoablation while the others started active surveillance. Median time to recurrence was 17.5 months (IQR: 7.8-27.3). Cancer-specific survival and metastasis-free survival were 100%, while overall survival was 86.7%. CA proved to be a valuable therapeutic option for the management of patients with cT1 high-complexity PADUA≥10 renal tumors as it provides a low rate of procedural morbidity and good preservation of renal function. However, these results are counterbalanced by a recurrence rate that appears to be higher than those reported on surgically treated patients.

Percutaneous Renal Cryoablation for Small Renal Masses: The Price is Right.

Percutaneous Renal Cryoablation for Small Renal Masses: The Price is Right.

Oncological outcomes of active surveillance and percutaneous cryoablation of small renal masses are similar at intermediate term follow-up.

Active surveillance (AS) and minimally invasive ablative therapies such as percutaneous cryoablation (PCA) are emerging as alternative treatment modalities in the management of small renal masses (SRMs). Fifty-nine patients underwent PCA since 2011 and 75 underwent AS since 2010 at two different institutions. Only patients with follow-up ≥6 months were included. All patients were followed with a standardized protocol. Treatment failure was defined by dimensional progression for AS and renal recurrence for PCA, in addition to stage and/or metastatic progression for both groups. Treatment failure was observed in 14 cases (18.7%) during AS (mainly due to dimensional progression) and 12 patients (16%) underwent delayed intervention with a mean follow-up of 36.83 months. Seven patients (11.9%) in the PCA group experienced treatment failure with a mean follow-up of 33.39 months and three of them underwent re-ablation successfully. Cancer-specific-survival at 2 and 5 years was 100% and 95,8% in AS-group vs. 98.2% and 98.2% in PCA-group (P=0.831). One patient in both groups died from metastatic disease. Overall-survival at 2 and 5 years was 91.7% and 82.4% in the AS group vs. 96.5% and 96.5% in the PCA group (P=0.113). Failure-free survival at 2 and 5 years was 90.9% and 70.1% in the AS group vs. 93.1% and 70.9% in the PCA group (P=0.645). AS and PCA provide similar survival outcomes and are safe and valid treatment options for elderly and comorbid patients with SRMs.

Laparoscopic cryoablation for small renal masses: Oncological outcomes at 5-year follow-up

ABSTRACT Objective: To evaluate the oncological outcome at 5-year follow-up after laparoscopic cryoablation (LCA) for small renal masses (SRMs), as there is an increasing interest in ablative therapy for cT1a renal tumours due to the rising incidence of SRMs, the trend towards minimally invasive nephron-sparing treatments, and the ageing population. Patients and methods: Between 2004 and 2015, 233 consecutive LCA were performed in 219 patients for SRMs at two referral centres. We only included those patients with ≥5 years of follow-up (n = 165) in a prospectively maintained database. A descriptive analysis was conducted for pre-, peri- and postoperative characteristics. A Kaplan–Meier analysis assessed overall (OS), disease-specific (DSS), and recurrence-free survival (RFS). Results: The median (interquartile range [IQR]) age of our patient cohort was 68 (60.5–76) years. The median (IQR) body mass index was 26.2 (23.8–29) kg/m2, and the median (IQR) Charlson Comorbidity Index score corrected for age was 4 (2.5–6). The median (IQR) tumour diameter was 28 (21–33) mm. In all, 15% developed a complication in the first 30 days after LCA, of which 1% had a major complication (Clavien–Dindo Grade ≥III). The median (IQR) preoperative estimated glomerular filtration rate (eGFR) was 82.5 (65–93.75) mL/min/1.73 m2. The median eGFR decreased by 16.4% and 15.2% at the 3-month and 5-year follow-up, respectively. Persistence was found in 1%, local recurrence in 2%, and systemic progression in 4%. The OS, DSS, and RFS were 74%, 96.9% and 95.4%, respectively. Conclusion: LCA is a safe and effective treatment for SRMs in selected cases and shows good oncological outcomes after 5 years of follow-up, with only 1% developing a major complication.

Mini invasive approaches in the treatment of small renal masses: TC-guided renal cryoablation in elderly

Today, the goal of surgery is to achieve oncological efficacy with the lowest complication rate. Computed Tomography (CT)-guided cryoablation is proposed as a safe and effective technique. We report, our series of small renal masses treated with cryoablation in elderly (> 70 years). From May 2014 to April 2019, 32 patients with median (IQR) age of 75.5 years (range 71-80) with small renal masses (< T1a) diagnosis, clinical anesthesia contraindications to nephron-sparing surgery or patient's will previous informed consent have been selected at our Urology Department. All patients underwent CT-guided cryoablation, preceded by needle biopsy. The cryoablation consisted in a procedure with an argon/helium gas-based system under local anesthesia. The follow-up included CT abdomen at 3, 6 and 12 months. The definition of incomplete treatment was the persistence of the lesion contrast enhancement (CE) at the end of the scan; the definition of relapse was the appearance of the CE to the 6-month control CT. The median follow-up was 30 months (IQR 1-59). The median size of the tumor was 3.85 cm (IQR 1.6-4.5). All patients underwent lesion biopsy resulting in diagnosis of Renal Cell Carcinoma (RCC) in 29 patients (90.7%) and oncocytoma in 3 patients (9.3%). A median of 2 cryoprobes (IQR 1- 3) was used and 2/3 cycles of freeze-thaw of the duration of 10 minutes or 5 minutes were performed. Complications were: 3 asymptomatic transitional perirenal effusion, 2 lumbar pain well-controlled by analgesic drug. Hospital stay was 2 days (range 1-3). No case showed incomplete treatment and local relapse or metastates at the CT abdomen-pelvis with contrast medium at 12 months. This study shows the efficacy and safety of percutaneous cryoablation of small renal masses in elderly population. The procedure is easy to perform, with low complication rates and well tolerated by the elderly patients.

Renal mass cryoablation: Melting time analysis of radiographic ice-ball after 5-minute active thawing by using serial ultrasound

ObjectiveCryoneedles removal before sufficient thawing may lead to tissue damage and bleeding. We analyzed melting time of radiographic ice-ball in renal percutaneous cryoablation (PCA) using ultrasound. Materials and methodsConsecutive 27 patients who underwent PCA using cryoneedles of 2–4 for the renal mass (median size, 1.9 cm; range, 1.1–4.1 cm) were evaluated. Reconstructed CT images obtained during freezing were used to measure radiographic ice-ball volume. After completing final freezing, 5-min active thawing and following passive thawing were performed. Melting time of radiographic ice-ball during the thawing was analyzed by serial ultrasound examination. Melting time was defined as the time of complete disappearance of intrarenal posterior acoustic shadowing generated by radiographic ice-ball, which was analyzed by two independent radiologists. The relationship between total melting time and radiographic ice-ball volume was also analyzed by Spearman’s rank correlation. ResultsMedian radiographic ice-ball volume was 30.5 cm3 (range, 26.6–37.3 cm3). After 5-min active thawing, radiographic ice-ball needed additional passive thawing of median 8-min or 9-min for complete melting in analyses of two independent radiologists, respectively (p > 0.05). The range of total melting time during active and passive thawing was 9-min-to-15-min for both radiologists, respectively. A positive correlation was found between total melting time and radiographic ice-ball volume (Spearman’s rho, 0.644 and 0.479 for radiologist 1 and 2). ConclusionIn our PCA protocol, radiographic ice-ball needed approximately 10-min passive thawing after 5-min active thawing for complete melting. This may help determine safe removal time of cryoneedles.

599 - Laparoscopic cryoablation for small renal masses: Oncological outcomes at 5 year follow-up

Objective: To evaluate the oncological outcome at 5-year follow-up after laparoscopic cryoablation (LCA) for small renal masses (SRMs), as there is an increasing interest in ablative therapy for cT...