https://doi.org/10.4081/aiua.2020.4.309

Mini invasive approaches in the treatment of small renal masses: TC-guided renal cryoablation in elderly

Vol. 92 No. 4 (2020)
Submitted: May 10, 2020
Accepted: June 10, 2020
Published: December 17, 2020
Percutaneous renal cryoablation; Kidney cancer; Small renal masses; Elderly; Mini invasive
Abstract Views: 991
PDF: 547
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Authors

Oscar Selvaggio
oscarsel@libero.it
University of Foggia, Department of Urology and Organ transplantation, Foggia, Italy.
Giovanni Silecchia
University of Foggia, Department of Urology and Organ transplantation, Foggia, Italy.
Matteo Gravina
University of Foggia, Department of Radiology, Foggia, Italy.
Ugo Giovanni Falagario
University of Foggia, Department of Urology and Organ Transplantation, Foggia, Italy.
Giovanni Stallone
University of Foggia, Department of Nephrology, Foggia, Italy.
Luca Macarini
University of Foggia, Department of Radiology, Foggia, Italy.
Giuseppe Carrieri
University of Foggia, Department of Urology and Organ transplantation, Foggia, Italy.
Luigi Cormio
University of Foggia, Department of Urology and Organ Transplantation, Foggia; Department of Urology, Bonomo Teaching Hospital, Andria (BAT), Italy.

Background: Today, the goal of surgery is to achieve oncological efficacy with the lowest complication rate. Computed Tomography (CT)-guided cryoablation is proposed as a safe and effective technique. We report, our series of small renal masses treated with cryoablation in elderly (> 70 years).
Methods: From May 2014 to April 2019, 32 patients with median (IQR) age of 75.5 years (range 71-80) with small renal masses (< T1a) diagnosis, clinical anesthesia contraindications to nephron-sparing surgery or patient’s will previous informed consent have been selected at our Urology Department. All patients underwent CT-guided cryoablation, preceded by needle biopsy. The cryoablation consisted in a procedure with an argon/helium gas-based system under local anesthesia. The follow-up included CT abdomen at 3, 6 and 12 months. The definition of incomplete treatment was the persistence of the lesion contrast enhancement (CE) at the end of the scan; the definition of relapse was the appearance of the CE to the 6-month control CT.
Results: The median follow-up was 30 months (IQR 1-59). The median size of the tumor was 3.85 cm (IQR 1.6-4.5). All patients underwent lesion biopsy resulting in diagnosis of Renal Cell Carcinoma (RCC) in 29 patients (90.7%) and oncocytoma in 3 patients (9.3%). A median of 2 cryoprobes (IQR 1- 3) was used and 2/3 cycles of freeze-thaw of the duration of 10 minutes or 5 minutes were performed. Complications were: 3 asymptomatic transitional perirenal effusion, 2 lumbar pain well-controlled by analgesic drug. Hospital stay was 2 days (range 1-3). No case showed incomplete treatment and local relapse or metastates at the CT abdomen-pelvis with contrast medium at 12 months.
Conclusions: This study shows the efficacy and safety of percutaneous cryoablation of small renal masses in elderly population. The procedure is easy to perform, with low complication rates and well tolerated by the elderly patients.

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How to Cite

Selvaggio, O., Silecchia, G., Gravina, M., Falagario, U. G., Stallone, G., Macarini, L., Carrieri, G., & Cormio, L. (2020). Mini invasive approaches in the treatment of small renal masses: TC-guided renal cryoablation in elderly. Archivio Italiano Di Urologia E Andrologia, 92(4). https://doi.org/10.4081/aiua.2020.4.309

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