Cryoablation Of Renal Masses Research Articles

Intermediate to Long-Term Clinical Outcomes of Percutaneous Cryoablation for Renal Masses

PurposeThe purpose of this study was to evaluate the effectiveness and adverse outcomes of percutaneous cryoablation (CA) for treatment of renal masses in a large cohort of patients. Materials and MethodsThis retrospective analysis included 299 CA procedures (297 masses in 277 patients) performed between July 2007 and May 2018 at a single institution. The mean patient age was 66.1 years (range, 30–93 years) with 65.8% being male. A total of 234 (78.8%) masses were biopsy-proven renal cell carcinoma (RCC). The mean maximal tumor diameter was 2.5 cm (range, 0.7–6.6 cm). Efficacy was assessed only for ablations of biopsy-proven RCC, whereas the evaluation of adverse events and renal function included all masses. Complications were graded according to the Society of International Radiology classification. ResultsMajor complications occurred in 3.0% of procedures (n = 9), none of which resulted in death or permanent disability. The mean imaging follow-up period was 27.4 months (range, 1–115) for the 199 RCC patients (204 ablated tumors) with follow-up imaging available. Complete response on initial follow-up imaging at mean 4.2 months (range, 0.3–75.6) was achieved in 195 of 204 tumors (95.6%) after a single session and in 200 of 204 tumors (98.0%) after 1 or 2 sessions. Of the RCC patients achieving complete response initially, local recurrence during the follow-up period occurred in 3 of 200 tumors (1.5%). Metastatic progression occurred in 10 of 193 (5.2%) RCC patients without prior metastatic disease during follow-up. ConclusionsCA for renal masses is safe and remains efficacious through intermediate- and long-term follow-up.

Safety and effectiveness of percutaneous renal cryoablation with conscious sedation

ABSTRACT Objective To investigate complications and treatment failure rates of percutaneous renal cryoablation (PRC) for small renal masses under local anaesthesia and conscious sedation (LACS), to assess the safety and effectiveness of this approach, as PRC is typically performed under general anaesthesia (GA). Patients and methods We retrospectively reviewed PRC under LACS from 2003 to 2017. We analysed perioperative parameters between patients who successfully underwent PRC under LACS and patients with post-procedural complications or treatment failure (renal mass enhancement after successful intraoperative tumour ablation). Two-sided non-parametric and Fisher’s exact tests were performed to compare uncomplicated or disease-free PRC with the complication or treatment failure group, respectively. Results A total of 100 PRCs under LACS were performed during the study period. Of these patients, six patients had at least one postoperative complication (6%), and treatment failure was diagnosed in nine patients (9%) after PRC [mean (SD) follow-up of 42.7 (26.6) months]. The procedural failure rate was 1%. No ablations were converted to GA. The mean tumour size was smaller in patients who had no complications during PRC compared to those who did, at a mean (SD) of 2.2 (0.6) cm vs 3.0 (1.0) cm (P = 0.039). The use of more intraoperative probes during the PRC was also associated with complications, at a mean (SD) 3.0 (1.4) vs 1.8 (0.8) (P = 0.021). Conclusions PRC under LACS is an effective and safe procedural approach for managing small renal masses with low complication, treatment failure, and procedural failure rates. Larger renal masses and intraoperative use of multiple probes is associated with an increased risk of PRC complications. Abbreviations BMI: body mass index; CCI: Charlson Comorbidity Index; GA: general anaesthesia; LACS: local anaesthesia and conscious sedation; PRC: percutaneous renal cryoablation; R.E.N.A.L.: Radius, Exophytic/Endophytic, Nearness, Anterior/Posterior, Location

Abstract No. 515 Renal tumor biopsy following percutaneous cryoablation of renal masses

Percutaneous tumor biopsy is recommended prior to percutaneous ablation of renal masses; however, reported complications of hemorrhage in up to 91% of cases in addition to probe crowding in small lesions may negatively affect mass visualization. Post biopsy track seeding is a rare, but biopsy of ablated tissue might decrease the probability. Tumor histology is readily identifiable after freezing. We report our experience of performing renal biopsy following percutaneous cryoablation of solid renal masses in order to assess the safety and feasibility of this technique. From December 2018 to July 2019, 8 patients with solid renal masses (1.6 to 2.2 cm) per contrast-enhanced MRI or CT concerning for malignancy underwent single session CT-guided percutaneous cryoablation and subsequent biopsy of ablated tissue. Cryoablation was performed under CT and ultrasound guidance. An iceball margin of > 5 mm was confirmed prior to thawing and probe removal. Core biopsy was subsequently performed with an 18-gauge coaxial needle of the visible mass within the treated volume. Samples were submitted to pathology in formalin and underwent routine processing. All patients were subsequently followed in clinic with repeat imaging every 3 months. There were no post procedure adverse events related to biopsy. Median follow-up for the cohort was 154 days (IQR 191 days). All ablated lesions demonstrated complete response per MRI and CT (2-7 months). Histologic diagnostic quality was adequate for all submitted specimens yielding renal cell carcinoma or oncocytoma in 6 and 2 patients, respectively (Table 1). Diagnostic core biopsy of renal masses immediately post cryoablation is both safe and feasible. Potential benefits of this approach should be validated in future studies.Table 1Renal Cell Carcinoma TypeGradeClear cell2Clear cell3PapillaryLowClear cell papillaryLowChromophobeLowChromophobe- Open table in a new tab

Abstract No. 602 Burn or freeze: meta-analysis comparing microwave versus cryoablation in the treatment of T1a renal masses

To compare the outcomes of microwave ablation (MWA) vs. cryoablation (CA) for T1a renal masses. A review of literature for studies from MEDLINE and EMBASE from 2005 to 2019 was performed without language restrictions. Inclusion criteria were 1- stage T1a renal cell carcinoma (RCC), 2- use of CA or MWA percutaneously, 3- case series or retrospective studies with >15 patients and, 4- reported outcomes of local recurrence, overall survival (OS) and complications. When available, complications were quantified for MWA and CA for each study. When recurrence rates or complication rates or OS were not included in a study, that study population was not included in the relevant calculations. Studies with overlapping populations were excluded. The analysis was carried SPSS software. For categorical variables, counts or proportions were extracted from each study and merged. For continuous variables means and standard deviations were extracted and merged. We used the chi-square test for analyzing baseline characteristics of patients. Complications and recurrences were calculated as odds ratios with 95% confidence intervals. A test of heterogeneity of included studies was conducted, sensitivity analysis and publications bias were also done. A total of 29 studies (12 MWA and 17 CA) met the inclusion criteria with overall 3763 patients (3139 patients in CA and 624 patients in MWA). The pooled proportion of patients for recurrence was 1270 patients (898patients in CA and 372 patients in MWA) and 1523 patients for complications (1106 CA and 417 MWA). For 2-year OS, 2054 patients were included in analysis (1932 for CA and 122 for MWA). In the pooled results, complication rates were not statistically significantly different between CA (11.8%) and MWA (12.0%) (OR: 0.99 95% CI = 0.705-1.410 P = 0.876). The local recurrence rate was 10.5% for CA vs. 5.9% for MWA which was statistically significant (OR: 0.53 95%CI = 0.332-0.870 P = 0.01). There was a difference in 2 years OS between CA (73%) versus MWA (93.4%) (OR: 0.19 95% CI: 0.092-0.393 P = 0.0001). In our meta-analysis, MWA and CA did not show a difference in complications, but local recurrence was lower with MWA and 2-year survival was better.

Renal Function Loss After Cryoablation of Small Renal Masses in Solitary Kidneys: European Registry for Renal Cryoablation Multi-Institutional Study.

Objectives: To estimate and quantify the loss of kidney function in solitary kidneys with small renal masses (SRMs) after laparoscopy-assisted renal cryoablation (LARC), from the European Registry for Renal Cryoablation (EuRECA) database. Patients and Methods: Of the 808 patients from eight European centers in the database, 102 patients had SRMs in solitary kidneys. Patient demographics, body mass index (BMI), American Society of Anesthesiologists (ASA) grade, Charlson comorbidity index, and tumor characteristics including nephrometry (PADUA) score where available were collected. Renal function data in the form of estimated glomerular filtration rate (eGFR) and chronic kidney disease (CKD) stratification both preoperatively and at 3 months postoperatively were collected. Results: The median (interquartile range [IQR]) age was 67 (59-81) years, the median (IQR) BMI was 26 (23.9-28.9) kg/m2, and the median (IQR) ASA score was 2 (2-3). The median Charlson score was 4 (range: 0-10). The median (IQR) tumor size in cross-sectional imaging was 26 (19-38) mm. The follow-up data were available for 72 patients with a median follow-up for this group of 38 (range: 10-132) months. The mean preoperative eGFR was 55.0 mL/minute/1.73 m2 (standard deviation [SD] = 18.1), and the mean postoperative eGFR was 51.8 mL/minute/1.73 m2 (SD = 18.8). The change was -3.1 mL/minute/1.73 m2 (95% confidence interval -5.2 to -1.0) units, which was statistically significant (p = 0.004). The change in the CKD stages comparing before and after LARC was not significant (paired two-tailed t-test, p = 0.06). Critically, the decrease in the eGFR did not translate to any significant adverse outcome and zero patients required dialysis. Conclusion: To the best of our knowledge, this is the largest study of renal function after LARC in SRMs in solitary kidneys. Cryotherapy in this imperative situation is safe, carries clinically insignificant reduction in renal function, therefore providing an option to minimize the risk of developing renal failure necessitating dialysis.

Early trends and predictors of renal function following computed tomography-guided percutaneous cryoablation of a renal mass in patients with and without prior renal impairment.

ObjectiveTo assess trends and predictors of the glomerular filtration rate (GFR) after renal mass cryoablation in patients with and without history of renal impairment.Materials and MethodsThis was a retrospective study of 39 patients who underwent computed tomography-guided percutaneous cryoablation of a renal mass, divided into two groups: those with prior renal impairment (PRI+); and those without prior renal impairment (PRI−). The GFR trend and the chronic kidney disease stage were evaluated at baseline, as well as at 1, 6, and 12 months after cryoablation. Predictors of GFR at 1 and 6 months were modeled with linear regression.ResultsIn both groups, the mean GFR at 1 month and 6 months was significantly lower than at baseline (p < 0.001 and p = 0.01, respectively). Although the GFR was lower across all time points in the PRI+ group (−26.1; p < 0.001), the overall trend was not statistically different from that observed in the PRI− group (p = 0.89). Univariate analysis showed that the decline in GFR at 1 and 6 months correlated with the baseline GFR (0.77 and 0.63; p < 0.001 and p = 0.03, respectively) and with the size of the ablation zone (−7.6 and −12.84, respectively; p = 0.03 for both). However, in the multivariate model, baseline GFR was predictive only of GFR at 1 month (p < 0.001).ConclusionThe trend in GFR decline after cryoablation is similar for patients with and without a history of renal impairment. Baseline GFR predicts the mean GFR in the early post-cryoablation period.

Oncologic Outcomes Following Partial Nephrectomy and Percutaneous Ablation for cT1 Renal Masses

BackgroundLong-term data comparing partial nephrectomy (PN) and thermal ablation are lacking. ObjectiveTo update our experience with PN, percutaneous radiofrequency ablation (RFA), and percutaneous cryoablation for cT1 renal masses. Design, setting, and participantsA total of 1798 patients with primary cT1N0M0 renal masses treated between 2000 and 2011 at Mayo Clinic were identified. InterventionPercutaneous ablation versus PN. Outcome measurements and statistical analysisCancer-specific survival (CSS) was estimated using the Kaplan-Meier method. Local recurrence, metastases, and death from renal cell carcinoma (RCC) were compared with propensity-score–adjusted Cox models. Results and limitationsAmong 1422 cT1a patients, 1055, 180, and 187 underwent PN, RFA, and cryoablation with median clinical follow-up of 9.4, 7.5, and 6.3yr, respectively. Comparisons of RFA with PN resulted in hazard ratios (HRs) of 1.49 (95% confidence interval [CI] 0.55–4.04, p=0.4), 1.46 (95% CI 0.41–5.19, p=0.6), and 1.99 (95% CI 0.29–13.56, p=0.5) for local recurrence, metastases, and death from RCC. Comparisons of cryoablation to PN resulted in HRs of 1.88 (95% CI 0.76–4.66, p=0.18), 0.23 (95% CI 0.03–1.72, p=0.15), and 0.29 (95% CI 0.01–6.11, p=0.4) for these same outcomes. Five-year CSS was 99%, 96%, and 100% for PN, RFA, and cryoablation, respectively. Among 376 cT1b patients, 324 and 52 underwent PN and cryoablation with median clinical follow-up of 8.7 and 6.0yr, respectively. Comparisons of cryoablation with PN resulted in HRs of 1.22 (95% CI 0.33–4.48, p=0.8), 0.95 (95% CI 0.21–4.38, p>0.9), and 1.94 (95% CI 0.42–8.96, p=0.4) for local recurrence, metastases, and death from RCC, respectively. Five-year CSS was 98% and 91% for PN and cryoablation, respectively. Limitations include retrospective review and selection bias. ConclusionsWith mature follow-up at a single institution, percutaneous ablation appears to have acceptable results for cT1 renal tumors and is appropriate for patients with a contraindication for surgery. For cT1a patients, clinically relevant differences between PN and ablation are unlikely, and treatment choice should involve shared decision making. For cT1b patients, death from RCC was more common with cryoablation, and large differences in this outcome cannot be ruled out. Further research is needed to confirm the oncologic effectiveness of cryoablation in the cT1b setting. Patient summaryWith appropriate patient triage, partial nephrectomy and percutaneous ablation can be used to treat cT1 renal masses, although additional follow-up and further study are still needed.

04:03 PM Abstract No. 90 Clinical outcomes of percutaneous cryoablation for small renal masses: a 10-year experience

Percutaneous cryoablation is safe and effective for the treatment of renal tumors, but studies examining long-term clinical outcomes are limited. The purpose of this study was to evaluate the effectiveness and adverse outcomes in a large cohort of patients undergoing percutaneous cryoablation for solid renal masses. This retrospective analysis included all 298 percutaneous cryoablation procedures (306 masses in 278 patients) performed between July 2007 and July 2018 at a single institution. The mean age in the cohort was 66.1 years (range, 30 – 93; 65.8% male). 244 masses were biopsy-proven renal cell carcinoma (RCC). Cross-sectional imaging analysis of recurrence rates, tumor staging, and long-term efficacy included only ablations for RCC. All patients were included in the analysis of procedure-related complications, including those for whom biopsy was not performed (n=8) and those with benign (n=15) or non-diagnostic (n=39) pathology. Complications were categorized according to the SIR Adverse Event Classification. The mean maximal tumor diameter was 2.3 cm (range, 0.7 - 6.6 cm). The average length of stay after cryoablation was 1.2 days (range, 1 - 8 days). Major complications occurred in 3.0% of procedures (n=9), with none resulting in death or permanent disability. There was no significant difference in pre-procedural estimated glomerular filtration rate (eGFR) and the eGFR at first follow-up (p=0.98). Among RCC patients with follow-up imaging available (n=219), the mean imaging follow-up period was 25.2 months (range, 1 – 100 months). Complete response on initial follow-up imaging was achieved in 96.3% (211 of 219) after a single session and 99.1% (217 of 219) after two sessions. Of the RCC patients achieving complete response, local recurrence during the follow-up period was seen in 2.3% (5 of 217). New metastatic disease developed in 2.7% (6 of 219) of RCC patients during follow-up. Percutaneous cryoablation is a safe and effective alternative to partial nephrectomy in the treatment of small renal masses.

916 - Comparison of perioperative and oncologic outcomes between cryoablation and partial nephrectomy for small renal masses: A propensity-score matching analysis

916 - Comparison of perioperative and oncologic outcomes between cryoablation and partial nephrectomy for small renal masses: A propensity-score matching analysis

Cryoablation versus Partial Nephrectomy for Clinical Stage T1 Renal Masses: A Systematic Review and Meta-Analysis.

Introduction: Cryoablation has been considered as the most efficacious ablative alternative to partial nephrectomy (PN) for selected patients. Our objective is to assess the existing evidence relating to the safety and efficacy of cryoablation compared with PN for clinical T1 renal masses.Materials and Methods: A comprehensive search of PMC, EMBASE, and the Cochrane Library was conducted to identify studies containing comparison of cryoablation and PN. By utilizing those included studies, a systematic review and cumulative meta-analyses were performed to assess the safety and efficacy between cryoablation and PN for T1 renal masses.Results: 17 retrospective studies providing available data were included in our study. Significant differences were found about all oncological variables including all-cause death, cancer-specific death, metastasis and local-recurrence (p < 0.001, p = 0.03, p < 0.001, and p < 0.001, respectively) between the PN group and the cryoablation group. The mean difference between two groups for percent estimated glomerular filtration rate decrease and creatinine increase was -4.84 and 0.15 respectively (p < 0.001 and p = 0.006, respectively). The incidences of overall and postoperative complications in the PN group were significantly higher than that in the cryoablation group (p = 0.001 and p < 0.001, respectively), but the result about intraoperative complications didn't show a significant difference between the two groups (p = 0.53).Conclusions: Comparing with PN, cryoablation for clinical T1 renal tumors is associated with poorer oncological outcomes, but the existing disadvantages are accompanied by lower rate of overall and postoperative complications and superior renal functional preservation. For patients with imperative indications for nephron-sparing surgery who can't risk more invasive PN, cryoablation could be an attractive option. Owing to the inherent limitations of eligible studies, conclusions drawn from our meta-analyses should be interpreted cautiously and be confirmed further with well-designed randomized controlled trials with extensive follow-up length.

Correction to: Comparisons of percutaneous versus retroperitoneoscopic cryoablation for renal masses.

In the original publication, Prof. Lin-Nei Hsu's institution was incorrectly published as 'Tainan Municipal An-Nan Hospital' in affiliation 4. The correct affiliation should read as 'Department of Urology, An-Nan Hospital, China Medical University, Tainan, Taiwan'.

Prone transradial catheterization for combined single-session endovascular and percutaneous interventions: approach, technical success, safety, and outcomes in 15 patients

We aimed to report approach, safety, technical success, and clinical outcomes of prone trans- radial access (PTRA) and demonstrate feasibility for procedures requiring simultaneous arterial intervention and prone percutaneous access. Fifteen patients underwent PTRA, seven females (47%) and eight males (53%), mean age of 55 years (range, 19-78 years). All patients underwent PTRA for combined transarterial and posterior-approach percutaneous interventions. Variables included sheath size (French, F), type of anesthesia, arterial intervention technical success, posterior-approach percutaneous intervention technical success, estimated blood loss (mL), fluoroscopy and procedure time, complications, and follow-up. Mean sheath size was 4 F (range, 4-6 F; SD = 0.5). Arterial interventions included transarterial embolization of renal (n=6), hepatic (n=2), and pelvic vessels (n=2), diagnostic arteriography (n=4), and embolization of an arteriovenous malformation (n=1). Posterior-approach intervention technical success was 100% (15/15). PTRA technical success was 100% (15/15). Posterior-approach percutaneous interventions included retroperitoneal (n=5) and pelvic (n=1) mass biopsies, nephrostomy tube placement (n=2), cryoablation of pelvic (n=2) and renal (n=1) masses, sclerotherapy of arteriovenous malformations (n=2), foreign body removal from the renal collecting system (n=2), ablation of a renal tumor (n=1), intracavitary injection of pulmonary mycetoma (n=1), and ablation and cementoplasty of a vertebral body tumor (n=1). The biopsies were diagnostic (6/6). There were no minor or major access-site complications. PTRA is a safe and feasible method for performing combined arterial and posterior approach percutaneous interventions without the need for repositioning.

P239 - Active surveillance and percutaneous cryoablation of small renal masses: Comparison of mid-term oncological outcomes

P239 - Active surveillance and percutaneous cryoablation of small renal masses: Comparison of mid-term oncological outcomes

Infectious Outcomes from Renal Tumor Ablation: Prophylactic Antibiotics or Not?

Variability exists among institutions and physicians regarding the use of prophylactic antibiotics for ablation of renal tumors. The literature was reviewed for infectious complications vis-à-vis the reported use of prophylactic antibiotics for tumor ablation of renal neoplasms. PubMed was searched for articles reporting radiofrequency ablation, cryoablation, and microwave ablation of renal masses, both by percutaneous and laparoscopic approaches. Data regarding potentially infectious outcomes, prophylactic antibiotic use or not, patient information, lesion characteristics, and procedural specifics were extracted from relevant articles. Fifty-one articles met the inclusion criteria. Potentially infectious complications occurred in 74/6952 patients (1.06%) if fever is included, but only 29 patients (0.42%) if fever is excluded. Prophylactic antibiotics were reported in 373 patients and were not mentioned in 6579 patients. The incidence of fever was higher with the laparoscopic radiofrequency ablation and cryoablation compared to the percutaneous approach (p < 0.001). Prophylactic antibiotics seldom are used and/or reported in renal tumor ablation, and when they are, the antibiotic regimens vary widely. Even so, infectious complications in renal tumor ablation are uncommon. The similar and very low rates of infectious outcomes among ablation types and the two access approaches (laparoscopic and percutaneous) suggest that prophylactic antibiotics for routine renal tumor ablation are unnecessary.

Comparisons of percutaneous versus retroperitoneoscopic cryoablation for renal masses.

Preserving renal function and controlling oncological outcomes are pertinent while managing renal tumours. We compared outcomes of percutaneous cryoablation (PCA) and retroperitoneoscopic cryoablation (RCA) in patients with renal neoplasms. We identified 108 patients with renal tumours at two medical centres, where 63 patients received PCA and 45 patients underwent RCA from August 2009 to July 2015, and they were followed up until February 2017. We compared preoperative and postoperative parameters, namely gender, systemic diseases, age, American Society of Anesthesiologists score, body mass index (BMI), haemoglobin, the estimated glomerular filtration rate, tumour size, operative time, tumour type, Clavien-Dindo classification of surgical complications, and tumour recurrence, by using an independent sample t test, Pearson's Chi-square test, Fisher's exact test, a Mann-Whitney test, and a generalised linear model. Based on baseline characteristics, we found that the patients in the PCA group were older and had higher BMI than those in the RCA group, whereas the patients in the RCA group had more comorbidities than those in the PCA group. Retroperitoneoscopic and percutaneous methods had similar operative times, blood transfusion rates, postoperative fever episodes, and complication rates for either minor or major complications. However, the percutaneous method was associated with a shorter length of stay. No patient experienced deterioration in renal function until 2years after both procedures. Impaired renal function was found in both groups in the 3-year follow-up. In both groups, tumour recurrence was significant for tumours > 4cm. Our results confirm that both cryoablation methods (PCA and RCA) are safe and effective for renal cell carcinoma. Favourable oncological control was achieved in both groups if the renal tumour size was ≤ 4cm.

P40 - Oncological outcome of robotic tumorectomy versus cryoablation for renal masses: Comparison after matching on radiological stage and renal score

P40 - Oncological outcome of robotic tumorectomy versus cryoablation for renal masses: Comparison after matching on radiological stage and renal score

PD51-12 COMPARISON OF MID-TERM ONCOLOGICAL OUTCOMES OF ACTIVE SURVEILLANCE AND PERCUTANEOUS CRYOABLATION OF SMALL RENAL MASSES

You have accessJournal of UrologyKidney Cancer: Localized: Active Surveillance1 Apr 2018PD51-12 COMPARISON OF MID-TERM ONCOLOGICAL OUTCOMES OF ACTIVE SURVEILLANCE AND PERCUTANEOUS CRYOABLATION OF SMALL RENAL MASSES Paolo Umari, Michele Rizzo, Michele Billia, Nicola Pavan, Gaetano Chiapparrone, Giovanni Liguori, Fulvio Stacul, Monica Zacchero, Paolo De Angelis, Alessandro Volpe, and Carlo Trombetta Paolo UmariPaolo Umari More articles by this author , Michele RizzoMichele Rizzo More articles by this author , Michele BilliaMichele Billia More articles by this author , Nicola PavanNicola Pavan More articles by this author , Gaetano ChiapparroneGaetano Chiapparrone More articles by this author , Giovanni LiguoriGiovanni Liguori More articles by this author , Fulvio StaculFulvio Stacul More articles by this author , Monica ZaccheroMonica Zacchero More articles by this author , Paolo De AngelisPaolo De Angelis More articles by this author , Alessandro VolpeAlessandro Volpe More articles by this author , and Carlo TrombettaCarlo Trombetta More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2018.02.2352AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Partial nephrectomy (PN) is considered the standard approach for small renal masses (SRMs). Active surveillance (AS) and ablative therapies represent emerging strategies for older and comorbid patients due to the indolent behaviour of most SRMs and to the high competing risk mortality. Aim of this study was to compare the mid-term oncological outcomes of AS and percutaneous cryoablation (PCA) of small renal masses (SRMs). METHODS Data regarding PCA and AS in patients with a single T1a renal tumors were collected prospectively at two large academic centers. 60 patients underwent PCA and 77 were enrolled in a AS protocol. The minimum follow-up period was 6 months. The most frequent indications for AS were severe comorbidities (48,1%), <15 mm renal masses (23,4%) and advanced age (15,6%). All patients in AS were followed with a standardized protocol including serial imaging (US, CT or MRI) every 6 months during the first 3 years and yearly thereafter. Tumor progression was defined as the reach of a 4 cm threshold in maximum diameter or a tumor volume doubling time <12 months. All PCA procedures were performed with a percutaneous approach. A double freeze-thaw cycle was performed using a mean of 2 sealed argon 17G cryoprobes per patient. Tumor progression after PCA was defined as a new nodular enhancement in the ablation zone or the enlargement of the ablated tumor 3 months after the treatment. RESULTS 14 masses showed dimensional progression during AS and 9 were surgically removed after a median follow-up of 30 months. 3 patients in the PCA group experienced progression and underwent a repeat ablation with a median follow-up of 24 months. Progression free survival (PFS) at 2 years was 94,8% and 95,0% for AS and PCA group, respectively. None of the patients progressed to metastatic disease. Overall survival at 2 years was 93,5% and 95,0% in the AS and PCA group, respectively. In the PCA group the complication rate was 5% (Clavien grade 1-2). CONCLUSIONS There are no good quality studies comparing the oncological outcomes of AS and PCA. Comparing AS to an active treatment is not an easy task due to the different definitions of the oncological endpoints such as PFS. With these limitations this study shows that both AS and PCA represent viable and safe treatment options for elderly and comorbid patients with SRMs. © 2018FiguresReferencesRelatedDetails Volume 199Issue 4SApril 2018Page: e980 Advertisement Copyright & Permissions© 2018MetricsAuthor Information Paolo Umari More articles by this author Michele Rizzo More articles by this author Michele Billia More articles by this author Nicola Pavan More articles by this author Gaetano Chiapparrone More articles by this author Giovanni Liguori More articles by this author Fulvio Stacul More articles by this author Monica Zacchero More articles by this author Paolo De Angelis More articles by this author Alessandro Volpe More articles by this author Carlo Trombetta More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

655 - Comparison of mid-term oncological outcomes of active surveillance and percutaneous cryoablation of small renal masses

655 - Comparison of mid-term oncological outcomes of active surveillance and percutaneous cryoablation of small renal masses

652 - Oncological outcome of robotic tumorectomy versus cryoablation for renal masses: Comparison after matching on radiological stage and renal score

652 - Oncological outcome of robotic tumorectomy versus cryoablation for renal masses: Comparison after matching on radiological stage and renal score

Safety and Efficacy of Cryoablation of Renal Tumors in a High-Risk Patient Population at a Community Hospital

Purpose: The purpose of the study was to evaluate the safety and efficacy of percutaneous cryoablation for the treatment of renal masses in a high surgical risk population stratified by Charlson Comorbidity Index treated at a community hospital and to determine parameters associated with higher complication rates. Materials and Methods: A retrospective chart review of patients with renal masses treated with image-guided percutaneous cryoablation between 2007 and 2013 was performed. Results: A total of 121 tumors were ablated in 105 patients. The mean patient age was 70 years old. Comorbidities included morbid obesity, hypertension, diabetes mellitus, coronary artery disease, pulmonary disease, cigarette use, and renal insufficiency. Mean tumor size treated was 3.15 cm in largest diameter, ranging from 1.4 to 6.5 cm. Complications were observed in 16 cases. The most common complication was perinephric and/or pararenal hemorrhage. Procedures with &gt;3.5 probes, hemoglobin &gt;12.5 g/dl, tumor size &gt;3.55 cm, and age &gt;75 years were all associated with greater likelihood of complications. Conclusions: Our experience with percutaneous cryoablation of small renal masses offers similar results in efficacy to published data in patients with significant comorbidities. In addition, the results of our study show that percutaneous cryoablation is relatively safe in patients with renal cancer who are poor surgical candidates but warrants special consideration. Parameters associated with higher rates of complications have been established, which may be used by physicians as a guide.