Cryoablation of small kidney tumors

Zondervan, Patricia J.; Buijs, Mara; Rosette, Jean J. de la; Delden, Otto van; Lienden, Krijn van; Laguna, M. Pilar

doi:10.1016/j.ijsu.2016.06.049

Cited by 24 publications

(30 citation statements)

References 52 publications

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“…Contrary to our previous published series, we experienced considerably fewer hemorrhagic complication rates, with only three events requiring ablation should be performed. Recent analyses have begun to indicate that among ablative technologies, cryoablation may deliver more consistent results in terms of local progression-free survival (17,18), certainly for tumors larger than 40 mm (19,20), although this may prove difficult to demonstrate in a randomized setting (21).…”

Section: Discussionmentioning

confidence: 99%

Image-guided Cryoablation for Sporadic Renal Cell Carcinoma: Three- and 5-year Outcomes in 220 Patients with Biopsy-proven Renal Cell Carcinoma

et al. 2018

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Purpose To evaluate the long-term efficacy of image-guided cryoablation of sporadic clinical T1 (cT1) biopsy-proven renal cell carcinoma (RCC) and the technical success and safety of all cryoablation treatments. Materials and Methods For this retrospective single-institution study, 433 patients (median age, 68 years; range, 19-90 years), of whom 293 were men (median age, 69 years; range, 19-90 years) and 140 were women (median age, 68 years; range, 30-89 years), who had 484 cT1 renal masses (mean size, 33 mm) and who were treated between 2007 and 2016 were identified from a prospectively maintained tumor registry. Treatment efficacy for all treated lesions and complication rates of all procedures were computed. Oncologic outcomes for a subset of 220 patients with sporadic biopsy-proven RCC were analyzed. The Kaplan-Meier method was used to estimate local recurrence-free survival (LRFS), metastasis-free survival (MFS), and overall survival (OS) rates. Results Of the 484 treated cT1 renal masses, 474 were imaged subsequently, with a primary treatment efficacy of 96% (453 of 474), increasing to 98% (465 of 474) after secondary ablation, and a major complication rate (Clavien-Dindo grade ≥ III) of 4.9% (23 of 473 procedures). The estimated LRFS and MFS rates, respectively, for the 220 patients with biopsy-proven RCC were 97.2% (95% confidence interval [CI]: 92.6%, 99.0%) and 97.7% (95% CI: 93.3%, 99.1%) at 3 years and 93.9% (95% CI: 85.8%, 97.4%) and 94.4% (95% CI: 86.7%, 97.7%) at 5 years. The estimated OS of all 433 patients was 91.7% (95% CI: 87.5%, 94.5%) and 78.8% (95% CI: 71.1%, 84.6%) at 3 and 5 years, respectively. Conclusion Five-year oncologic outcomes after image-guided cryoablation for clinical T1 renal cell carcinoma are competitive with those of resection at a lower complication rate. © RSNA, 2018.

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Section: Discussionmentioning

confidence: 99%

Image-guided Cryoablation for Sporadic Renal Cell Carcinoma: Three- and 5-year Outcomes in 220 Patients with Biopsy-proven Renal Cell Carcinoma

et al. 2018

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“…The latter will not be described in this review because open surgery is not desirable for mentioned patients with SRM, whereas laparoscopic technique is particularly useful for anterior tumors where there exists higher probability of damaging adjacent organs. Compared to laparoscopic NSS a lower complication rate is observed, but there is a higher probability of local recurrence [3,41]. Considering patient comorbidities and the general state of health which indicate that reducing the risk of procedural complications is essential, laparoscopic ablation is desirable for that group when the mentioned approach is needed.…”

Section: Ablation Approachmentioning

confidence: 99%

Active surveillance and focal ablation for small renal masses: a better solution for comorbid patients

Wośkowiak

Lewicka

Bureta

et al. 2020

aoms

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The natural history of small renal masses (SRM) is still not well understood and they are frequently incidentally diagnosed in elderly patients. Therefore, there is a need for less invasive options sparing the patient from the side-effects related to conventional surgical treatment. PubMed and Medline database search was performed to look for new findings on active surveillance and focal therapy for SRM. Sixty-one articles published between 2002 and 2018 were selected for the purpose of the review. There is growing evidence confirming the safety of active surveillance in patients at surgical risk and there appears to be a satisfactory intermediate-term outcome of focal treatment of SRM. In the group of elderly patients with a decreased life expectancy active surveillance appears to be the most appropriate approach. The future of minimally invasive therapy appears bright, especially with the improvement of new imaging modalities.

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“…Hence, the main disadvantages of LCA are [21] : (1) general anesthesia is required (it is not an outpatient procedure); (2) a higher rate of complication in comparison to PCA; (3) less rate of pain control and worst cosmetic in comparison to PCA; (4) higher cost rate in comparison to PCA.…”

Section: Advantages and Disadvantages Of Lcamentioning

confidence: 99%

Laparoscopic ablative techniques

Silvestri¹,

Concilio²,

Zeccolini³

et al. 2019

MIS

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Ablative techniques (AT) offer a combination of nephron-sparing and minimally invasive approaches. AT include different options and cryoablation (CA) and radiofrequency ablation (RFA) have been relatively safe and traditionally can be either performed laparoscopically or percutaneously. CA and RFA have emerged as a leading option for renal ablation, and compared with surgical techniques they offer benefits in preserving renal function with fewer complications, shorter hospitalization times, and allow for quicker convalescence. A mature dataset exists at this time, with intermediate and long-term follow up data available. Generally, laparoscopic access was the first technique used in the past, and typically for anterior and lateral mass. Afterwards, with the improvements in imaging and percutaneous techniques, laparoscopic approaches are progressively decreased and currently limited in few lesions and in relation with the surgeon's and center's experience. Nevertheless, laparoscopic CA and RFA could be useful techniques and currently, recommendations as a first-line therapy are made at this time in limited populations, including elderly patients, patients with multiple comorbidities, and those with imperative indications of a nephron sparing surgery. As more data emerge on oncologic efficacy, and technical experience continue to improve, the application of AT will likely be extended in future treatment guidelines and laparoscopic approaches will be a valid option in the era of tailored therapy.

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Cryoablation of small kidney tumors

Abstract: LoE 3a/b confirms lower CA perioperative complication rate and higher local progression rate than those for MIPN. CA preserves postoperative renal functional, without any evidence of differences in mid-/long-term follow-up compared to nephron sparing surgery.

Cited by 24 publications

References 52 publications

Image-guided Cryoablation for Sporadic Renal Cell Carcinoma: Three- and 5-year Outcomes in 220 Patients with Biopsy-proven Renal Cell Carcinoma

Image-guided Cryoablation for Sporadic Renal Cell Carcinoma: Three- and 5-year Outcomes in 220 Patients with Biopsy-proven Renal Cell Carcinoma

Active surveillance and focal ablation for small renal masses: a better solution for comorbid patients

Laparoscopic ablative techniques

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