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

Abstract

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.

The Impact of COVID-19 on New Kidney Cancer Diagnosis: Stage and Treatment in Northern Italy

“…Among the study’s limitations, we recall a need for more information on surgical schedule delays and even on survival, considering the short follow-up time. Information on specific treatments, such as cryoablation, could help in evaluating the impact of COVID-19 on surgery, as highlighted in a recent Italian work [ 49 ]. However, we could not address the issue since no cryoablation treatments were carried out in our province.…”

Management of small renal mass: unmet needs and quest for high quality evidence

“…In contrast, percutaneous CRA is gaining traction as an alternative to surgery in selected cases of SRMs, such as elderly patients, genetic predisposition to develop multiple tumors or contraindication to surgery ( 13 ). It demonstrated lower complication rates, preservation of long-term renal function and equivalent long-term oncological outcomes compared to surgical resection in selected patients ( 14 - 16 ). However, current guidelines recommend informing patients about the higher chance of tumor persistence or recurrence after primary TA techniques during counseling ( 17 ).…”

Cytoreductive Nephrectomy and Metastatic Renal Cell Carcinoma: State of the Art and Future Perspectives

“…Renal cell carcinoma (RCC) is the sixth most common cancer in males and the ninth most common cancer in females, accounting for 78,000 newly diagnosed cases in 2018 in the United States, representing the third leading cause of mortality amongst genitourinary malignancies [1]. Nowadays, radical nephrectomy is the gold standard for large and locally advanced RCC [2], while nephron sparing surgery is the preferred for smaller localized tumors with percutaneous tumor ablation recognized as a safe option [3][4][5][6]; metastatic RCC (mRCC) management is more demanding, with conflicting results reported. Indeed, 5-year survival rates for mRCC range from 0 to 20% [7][8][9].…”