CT-guided Percutaneous Cryotherapy of Renal Masses

Littrup, Peter J.; Ahmed, Abraham; Aoun, Hussein D.; Noujaim, Daniel L.; Harb, Ted; Nakat, Sam; Abdallah, Khaled Ben; Adam, B.; Venkatramanamoorthy, Raghu; Sakr, Wael; Pontes, J. Edson; Heilbrun, Lance K.

doi:10.1016/j.jvir.2006.12.007

Cited by 134 publications

(85 citation statements)

References 41 publications

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“…3,4,30 While segmental or laparoscopic resection remains the gold standard for treating amenable RCCs, recent data show acceptable results [6][7][8][9][10][11][12]14,[25][26][27]32 (98% tumour-free survival for segmental resection and a 93% to 98.7% tumour-free survival for cryoablation. [5][6][7][8][9][10][11]14,17,20,[25][26][27][28][29][32][33][34] The efficacy of cryoablation treating RCCs in our patients is 97% (68 of 70) based on imaging follow-up criteria (lack of enhancement of ablated tissue), which is similar to that reported in the literature (93.3%-98.7%). [7][8][9]12,14,22,23,[25][26][27]32,[34][35][36] Similar to reported experiences, we found that lesion location greatly affected the rate of success ...…”

Section: Discussionsupporting

confidence: 88%

“…It was difficult to create an adequate iceball to cover small lesions with 1 or 2 cryoprobes. [5][6][7]10,12,20,[25][26][27] Hence the high failure rate of 38% in this group (8 of 21 patients). Conversely, when using 3 or more cryoprobes, the rate of failure dropped to 18% (9 of 49 patients) ( Table 3).…”

Section: Resultsmentioning

confidence: 73%

“…The double freeze-thaw cycle has been shown to increase liquefaction necrosis and hence improve efficacy. 20,21 The interposed thawing causes cells to "burst" which is important to ensure cell death. [5][6][7][8][9][10][11]20,21 During the freezing cycle, limited CTs are obtained every 3 to 4 minutes to affirm coverage of the lesion by the iceball.…”

Section: Technique Of Cryoablationmentioning

confidence: 99%

“…[5][6][7][8][9][10][11]20,21 During the freezing cycle, limited CTs are obtained every 3 to 4 minutes to affirm coverage of the lesion by the iceball. 5,7,8,12,14,20 To identify possible "skip zones," a contrast-enhanced CT was obtained after the second freeze cycle. In 5 patients the positions of 13 cryoprobes had to be adjusted or cryoprobes added to cover the "skip zone" by the iceball.…”

Section: Technique Of Cryoablationmentioning

confidence: 99%

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Efficacy of percutaneous cryoablation of renal cell carcinoma in older patients with medical comorbidities: Outcome study in 70 patients

Lang

Zhang

Nguyen

et al. 2015

CUAJ

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Introduction: The aim of this study was to establish the efficacy of cryoablation for incidentally discovered small renal cell carcinomas in older patients with medical comorbidities. Methods: We carried out a retrospective chart analysis of outcomes of 70 patients treated by cryoablation. The inclusion criteria were age >56 years, medical comorbidities (Charlson class I-III), and suitability for cryoablation established by urologists and interventional radiologists. In total, 43 patients were male, 27 female, and the age range was 56 to 89. The lesions measured 1.5 to 4 cm; 29 were high-grade Fuhrman and 41 were low grade. All lesions were treated by 2 10-minute freezing cycles separated by an 8-minute thawing period. One to seven cryoprobes were inserted according to a preoperative, 3D computed tomography (CT)-based plan. Results: Results were assessed on follow-up CTs (at 8-9 months). Of the 70 patients, 68 were treated by cryoablations and surgical salvage procedures; these patients were free of disease for 23 to 72 months (mean 39). One patient experienced recurrence and the other was lost to follow-up. One or two cryoablations rendered 66 patients tumour-free and additional surgery rendered another 2 patients tumour-free. The location and configuration of the lesion affected outcomes. Of the 27 posterior lesions, there was 1 failure; of the postero-lateral lesions, there were 4 failures; of the anterior lesions, there were 5 lesions; finally of the 32 central or deep seated lesions, there were 9 failures. Implants with one and two cryoprobes had a high recurrence rate. Three major complications were managed by minor interventions. The mean hospitalization was 1.3 days and the procedure times were variable. Conclusion: Percutaneous cryoablation is recommended as a minimally invasive nephron-sparing treatment for amenable lesions in older patients with medical comorbidities.

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Section: Discussionsupporting

confidence: 88%

Section: Resultsmentioning

confidence: 73%

Section: Technique Of Cryoablationmentioning

confidence: 99%

Section: Technique Of Cryoablationmentioning

confidence: 99%

See 2 more Smart Citations

Efficacy of percutaneous cryoablation of renal cell carcinoma in older patients with medical comorbidities: Outcome study in 70 patients

Lang

Zhang

Nguyen

et al. 2015

CUAJ

View full text Add to dashboard Cite

show abstract

“…This may be of importance for patients who cannot undergo general anesthesia or receive deep moderate sedation due to medical co morbidities. In contrast to heat-based ablation modalities, the ice ball can be clearly seen with CT (Littrup et al, 2007;Solomon et al, 2004), MRI (Silverman et al, 2005), and ultrasound imaging (Gill et al, 2000). This imaging characteristic allows the operator to ascertain coverage of the tumor more confidently and also to better protect certain nearby critical structures.…”

Section: Ablation Proceduresmentioning

confidence: 99%