Safety and effectiveness of percutaneous renal cryoablation with conscious sedation

Abstract

Objective: To investigate complications and treatment failure rates of percutaneous renal cryoablation (PRC) for small renal masses under local anaesthesia and conscious sedation (LACS), to assess the safety and effectiveness of this approach, as PRC is typically performed under general anaesthesia (GA). Patients and methods: We retrospectively reviewed PRC under LACS from 2003 to 2017. We analysed perioperative parameters between patients who successfully underwent PRC under LACS and patients with post-procedural complications or treatment failure (renal mass enhancement after successful intraoperative tumour ablation). Two-sided non-parametric and Fisher's exact tests were performed to compare uncomplicated or disease-free PRC with the complication or treatment failure group, respectively. Results: A total of 100 PRCs under LACS were performed during the study period. Of these patients, six patients had at least one postoperative complication (6%), and treatment failure was diagnosed in nine patients (9%) after PRC [mean (SD) follow-up of 42.7 (26.6) months]. The procedural failure rate was 1%. No ablations were converted to GA. The mean tumour size was smaller in patients who had no complications during PRC compared to those who did, at a mean (SD) of 2.2 (0.6) cm vs 3.0 (1.0) cm (P = 0.039). The use of more intraoperative probes during the PRC was also associated with complications, at a mean (SD) 3.0 (1.4) vs 1.8 (0.8) (P = 0.021). Conclusions: PRC under LACS is an effective and safe procedural approach for managing small renal masses with low complication, treatment failure, and procedural failure rates. Larger renal masses and intraoperative use of multiple probes is associated with an increased risk of PRC complications.

Cryoablation of renal tumors: long-term follow-up from a multicenter experience

“…While admittedly, general anesthesia reduces intraoperative patient awareness and recall and offers pain control for prolonged periods of time, thereby allowing for more complex interventions [14], our approach was less invasive, allowing a more sparing use of material and personnel. A number of studies showed that cryoablation under local anesthesia and conscious sedation was as safe and effective as cryoablation under general anesthesia [11][12][13]. In center 1 anesthesiologists considered unfit for treatment with local anesthesia only uncooperative patients or patients who were possibly unable to keep prone position for the entire length of cryoablation.…”

“…Long-term efficacy results of RCC thermal ablation start being collected and 5-year outcomes of large series treated with cryoablation in single center teaching hospitals, often under general anesthesia, are available [8][9][10]. Cryoablation with local anesthesia and conscious sedation was reported as an alternative modality [11][12][13] and shortened perioperative time and hospital stay [12]. To our knowledge cryoablation under local anesthesia only was not reported so far.…”

Percutaneous CT-Guided Renal Cryoablation: Technical Aspects, Safety, and Long-Term Oncological Outcomes in a Single Center

“…Clavien-Dindo complications grade 3 to 5 have never occurred. The distribution of adverse events in this study is truly interesting since, in front of a meaningful higher rate of complications, there were no serious events requiring medical intervention while most of the authors, on the contrary, report some complications of grade 3 or even more in their series [10,15,18,21,35,36]. Some authors have chosen not to report complications below grade 3, evidently considering them not significant [7,29].…”