Percutaneous Ablation <i>vs</i> Robot-Assisted Partial Nephrectomy for Completely Endophytic Renal Masses: A Multicenter Trifecta Analysis with a Minimum 3-Year Follow-Up

Pandolfo, Savio Domenico; Beksaç, Alp Tuna; Derweesh, Ithaar; Celia, Antonio; Schiavina, Riccardo; Bianchi, Lorenzo; Costa, Giovanni; Carbonara, Umberto; Loizzo, Davide; Lucarelli, Giuseppe; Cerrato, Clara; Imbimbo, Ciro; Mirone, Vincenzo; Elbich, Jeffrey; Basile, Giuseppe; Hampton, Lance J.; Kim, Fernando; Capitanio, Umberto; Kaouk, Jihad; Autorino, Riccardo

doi:10.1089/end.2022.0478

Cited by 30 publications

(20 citation statements)

References 30 publications

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“…In recent years, thermal ablation has been gaining popularity, and is now accepted as one of the treatment methods in SRMs, including successful treatment of obese patients and cystic lesions [3,[20][21][22][23]. Some authors reported comparable results of thermal ablation and NSS in selected patients [9,20,24].…”

Section: Discussionmentioning

confidence: 99%

“…It must be stressed that percutaneous RFA is a minimally invasive treatment and can in certain cases be performed under local anaesthesia [8,13]. It is associated with shorter hospital stay than NSS (even robotic) and low complication rate, even in more challenging scenarios, such as endophytic tumour or tumour in single kidney [9,25,26].…”

Section: Discussionmentioning

confidence: 99%

“…The efficacy of thermal ablation has already been demonstrated, especially in case of SRMs, it is preferred for patients with renal masses ≤3 cm with contraindications or unwillingness to undergo surgery, especially people who are elderly, or have comorbidity, with bilateral tumours, and solitary kidney [4][5][6][7]. In addition to the good preservation of renal function, the percutaneous thermal ablation is also attractive because of much shorter hospital stay, lower cost, lower blood loss, shorter operative time, and acceptable morbidity in comparison to nephron sparing surgery (NSS) [2,4,8,9]. US-guided percutaneous ablation is particularly attractive because it is a relatively simple procedure and it can be performed by urologists skilled in US-guided techniques [2,10].…”

Section: Introductionmentioning

confidence: 99%

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Ultrasound-Guided Percutaneous Thermal Ablation of Renal Cancers—In Search for the Ideal Tumour

Jasiński

Bielinska

Siekiera

et al. 2023

Cancers

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Over the recent years, the progress in imaging techniques has led to an increased detection of kidney tumours, including small renal masses. While surgery is still the standard of care, there is a growing interest in minimally invasive methods. Ultrasound (US)-guided percutaneous ablation is particularly attractive because it is a safe and relatively simple procedure. In this study, we investigated the success of percutaneous radiofrequency ablation (RFA) in relation to kidney tumour diameter and location. Between August 2016 and September 2021, 253 patients with 259 renal tumours underwent US-guided RFA as a primary treatment in our institution. A total of 67 patients were excluded from this study. Abdominal computed tomography (CT) and tumour biopsy were performed before the procedure. Patients were followed with contrast-enhanced CT, the average follow-up time was 28 months. The studied group was composed of 186 patients with 191 renal tumours—only biopsy-confirmed renal cancers were included. During the follow-up, 46 cases of residual disease and 4 cases of local progression were found. There was a significant correlation between tumour size and the ablation success rate. The success rate was 73.5% and 87.6% for lesions ≤25 mm, 94.6% for lesions ≤25 mm and exophytic, 79.1% for lesions 26–30 mm and 84.4% for lesions 26–30 mm and exophytic, respectively. Four Clavien-Dindo grade ≥2 complications were observed. US-guided percutaneous RFA of T1a renal cancers is safe and well-tolerated. Its effectiveness depends on tumour size, with best results for exophytic lesions smaller than 3 cm. Most of the recurrent or residual tumours can be successfully re-treated with US-guided percutaneous RFA.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Ultrasound-Guided Percutaneous Thermal Ablation of Renal Cancers—In Search for the Ideal Tumour

Jasiński

Bielinska

Siekiera

et al. 2023

Cancers

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“…Of note, postoperative renal function impairment was recently demonstrated as a major factor for a decline in glomerular filtration rate at 1 year after partial nephrectomy [ 8 ]. However, as suggested in a study comparing robot-assisted partial nephrectomy and percutaneous tumor ablation with a follow-up of 3 years or more, impaired 1-year renal function may show some recovery over time [ 16 ].…”

Section: Discussionmentioning

confidence: 99%

Impact of Blood Loss on Renal Function and Interaction with Ischemia Duration after Nephron-Sparing Surgery

et al. 2022

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Objectives: Nephron-sparing surgery (NSS) exposes the kidney to ischemia–reperfusion injury. Blood loss and hypotension are also associated with kidney injury. We aimed to test the hypothesis that, during NSS, both ischemia duration and blood loss significantly affect postoperative renal function and that their effects interact. Methods: Consecutive patients undergoing NSS were enrolled. The primary endpoint was renal function expressed as the absolute delta between preoperative and postoperative peak creatinine. We developed a generalized linear model with the ischemia duration and absolute hemoglobin difference as independent variables, their interaction term, and the RENAL score. The model was than expanded to include a history of hypertension (as a proxy for hypotension susceptibility) and related interaction terms. Further, we described the perioperative and mid-term oncological outcomes. Results: A total of 478 patients underwent NSS, and 209 (43.7%) required ischemia for a mean of 10.9 min (SD 8). Both the ischemia duration (partial eta 0.842, p = 0.006) and hemoglobin difference (partial eta 0.933, p = 0.029) significantly affected postoperative renal function, albeit without evidence of a significant interaction (p = 0.525). The RENAL score also significantly influenced postoperative renal function (p = 0.023). After the addition of a previous history of hypertension, the effects persisted, with a significant interaction between blood loss and a history of hypertension (p = 0.02). Conclusions: Ischemia duration and blood loss had a similar impact on postoperative renal function, albeit without potentiating each other. While the surgical technique and ischemia minimization remain crucial to postoperative kidney function, increased awareness of conscious hemodynamic management appears warranted.

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“…CA of hepatocellular carcinomas (HCCs) results in 20% local and 60% distant recurrences [ 19 ]. Against the small T1a renal cell carcinomas, clinical outcomes following CA and partial nephrectomy are similar [ 20 , 21 , 22 , 23 , 24 , 25 , 26 ]. However, when renal tumors exceed 4 cm, CA results in inferior recurrence rates [ 27 , 28 ].…”

Section: Introductionmentioning

confidence: 99%

Focal Cryo-Immunotherapy with Intratumoral IL-12 Prevents Recurrence of Large Murine Tumors

Vrabel

Schulman

Gillam

et al. 2023

Cancers

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Focal ablation technologies are routinely used in the clinical management of inoperable solid tumors but they often result in incomplete ablations leading to high recurrence rates. Adjuvant therapies, capable of safely eliminating residual tumor cells, are therefore of great clinical interest. Interleukin-12 (IL-12) is a potent antitumor cytokine that can be localized intratumorally through coformulation with viscous biopolymers, including chitosan (CS) solutions. The objective of this research was to determine if localized immunotherapy with a CS/IL-12 formulation could prevent tumor recurrence after cryoablation (CA). Tumor recurrence and overall survival rates were assessed. Systemic immunity was evaluated in spontaneously metastatic and bilateral tumor models. Temporal bulk RNA sequencing was performed on tumor and draining lymph node (dLN) samples. In multiple murine tumor models, the addition of CS/IL-12 to CA reduced recurrence rates by 30–55%. Altogether, this cryo-immunotherapy induced complete durable regression of large tumors in 80–100% of treated animals. Additionally, CS/IL-12 prevented lung metastases when delivered as a neoadjuvant to CA. However, CA plus CS/IL-12 had minimal antitumor activity against established, untreated abscopal tumors. Adjuvant anti-PD-1 therapy delayed the growth of abscopal tumors. Transcriptome analyses revealed early immunological changes in the dLN, followed by a significant increase in gene expression associated with immune suppression and regulation. Cryo-immunotherapy with localized CS/IL-12 reduces recurrences and enhances the elimination of large primary tumors. This focal combination therapy also induces significant but limited systemic antitumor immunity.

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Percutaneous Ablation vs Robot-Assisted Partial Nephrectomy for Completely Endophytic Renal Masses: A Multicenter Trifecta Analysis with a Minimum 3-Year Follow-Up

Cited by 30 publications

References 30 publications

Ultrasound-Guided Percutaneous Thermal Ablation of Renal Cancers—In Search for the Ideal Tumour

Ultrasound-Guided Percutaneous Thermal Ablation of Renal Cancers—In Search for the Ideal Tumour

Impact of Blood Loss on Renal Function and Interaction with Ischemia Duration after Nephron-Sparing Surgery

Focal Cryo-Immunotherapy with Intratumoral IL-12 Prevents Recurrence of Large Murine Tumors

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