Percutaneous cryoablation of renal tumours: outcomes from 171 tumours in 147 patients

Abstract

Objective To evaluate the technical and oncological efficacy of an image‐guided cryoablation programme for renal tumours. Patients and Methods A prospective analysis of technical and radiological outcomes was undertaken after treatment of 171 consecutive tumours in 147 patients. Oncological efficacy in a subset of 125 tumours in 104 patients with >6 months' radiological follow‐up and a further subset of 62 patients with solitary, biopsy‐proven renal carcinoma was also analysed. Factors influencing technical success, as determined by imaging follow‐up, and complication rates were statistically analysed using a statistics software package and logistic regression analyses. Results No variables were found to predict subtotal treatment, although gender (P = 0.08), tumour size of >4 cm (P = 0.09) and central location of tumour (P = 0.07) approached significance. Upper pole location was the single variable that was found to predict complications (P = 0.006). Among the 104 patients (125 tumours), radiologically assessed at ≥6 months and with a mean radiological follow‐up of 20.1 months, we found a single case of unexpected late local recurrence. Conclusion Percutaneous image‐guided cryoablation, at a mean of 20.1 months' follow‐up, appears to provide a safe and effective treatment option with a low complication rate. Anteriorly sited tumours should not be considered a contraindication for percutaneous image‐guided cryoablation.

Computed Tomography Perfusion, Magnetic Resonance Imaging, and Histopathological Findings After Laparoscopic Renal Cryoablation: An In Vivo Pig Model

“…1 During the past decade, ablative techniques have proved effective in selected patients in whom the modality has the potential benefits of low complication rates, decreased morbidity, and good oncological outcomes. [2][3][4] However, in contrast to partial nephrectomy, cryoablation leaves no specimen for postoperative confirmation of the surgical margin, making the modality strongly dependent on follow-up imaging. Although postoperative contrast enhancement of a cryolesion can be a disturbingly and suspicious finding, it does not necessarily equal treatment failure.…”

Current Technique and Application of Percutaneous Cryotherapy

“…For example, Breen et al were able to show in 171 T1a/b tumors with an average follow-up period of 20.1 months that treatment is also safe in patients with relevant comorbidities (Charlson Index Score = 7.15) with 4.6 % Clavien-Dindo grade 2 complications. Only one case of local tumor relapse occurred during follow-up and was accessible for another cryotherapy procedure [17]. Georgiades found a 5-year overall survival rate of 97 % with a tumor-specific overall survival rate of 100 % in 134 histologically verified T1a/b renal cell carcinomas.…”

Ablative Therapies for the Treatment of Small Renal Masses: a Review of Different Modalities and Outcomes

“…This is more likely to occur in tumors near the collecting system or ureter [55,56]. CA, in comparison, has a relatively low risk of collecting system injury with reports of urine leak in only 1-2 % of cases [57,58].…”