Mini invasive approaches in the treatment of small renal masses: TC-guided renal cryoablation in elderly
https://doi.org/10.4081/aiua.2020.4.309
Accepted: June 10, 2020
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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.
Jason, M.; Sanders, H. Increased incidence of serendipitously discovered renal cell carcinoma. Urology 1998, 51, 203–5. DOI: https://doi.org/10.1016/S0090-4295(97)00506-2
Bretheau, D.; Koutani, A. A French national epidemiologic survey on renal cell carcinoma: Oncology Committee of the Association Francaise d’Urologie. Cancer 1998, 82, 538–44. DOI: https://doi.org/10.1002/(SICI)1097-0142(19980201)82:3<538::AID-CNCR16>3.0.CO;2-2
Gudbjartsson, T.; Einarsson, G.V. A population-based analysis of survival and incidental diagnosing of renal cell carcinoma in Iceland 1971–1990. Scand. J. Urol. Nephrol. 1996, 30, 451–5.
Sweeny, J.P.; Thornhill, J.A. Incidentally detected renal cell carcinoma: pathological features, survival trends, and implications for treatment. Br. J. Urol. 1996, 78, 351–3.
Homma, Y.; Kawabe, K. Increased incidental detection and reduced mortality in renal cancer-recent retrospective analysis at eight institutions. Int. J. Urol. 1995, 2, 77–80.
Chow, W.H.; Devesa, S.S. Rising Incidence of Renal Cell Cancer in the United States. JAMA. 1999, 281, 1628–31.
DeCastro, G.J.; McKiernon, J.M. Epidemiology, clinical staging, and presentation of renal cell carcinoma. Urol Clin North Am. 2008, 35, 581–92.
Kummerlin, I.; Ten Kate, F. Core biopsies of renal tumors: A study on diagnostic accuracy, interobserver and intraobserver variability. Eur Urol. 2008, 53, 1219–25.
Pierorazio, P.M.; Johnson, M.H. Management of renal masses and localized renal cancer: systematic review and metaanalysis. J Urol 2016, 196, 989–99.
Uzzo, R.G.; Novick, A.C. Nephron sparing surgery for renal tumors: indications, techniques and outcomes. J Urol 2001, 166, 6–18.
Gill, I.S.; Novick, A.C. Laparoscopic renal cryoablation: initial clinical series. Urology 1998, 52, 543–551.
Gill, I.S.; Desai, M.M. Laparoscopic partial nephrectomy for renal tumor: duplicating open surgical techniques. J Urol 2002, 167, 469–477.
Ukimura, O.; Kawauchi, A. Radio-frequency ablation of renal cell carcinoma in patients who were at significant risk. Int J Urol 2004, 11, 1051–1057. DOI: https://doi.org/10.1111/j.1442-2042.2004.00966.x
Gill, I.S. Minimally invasive nephron-sparing surgery. Urol Clin N Am 2003, 30, 551–579. DOI: https://doi.org/10.1016/S0094-0143(03)00030-2
Silverman, S.G.; Tuncali, K. Renal tumors: MR imaging- guided percutaneous cryotherapy—initial experience in 23 patients. Radiology 2005, 236, 716–724.
Bassignari, M.J.; Moore, Y. Pilot experience with real-time ultrasound guided percutaneous renal mass cryoablation. J Urol 2004, 171, 1620– 1623.
Andrews, J.R.; Atwell, T. Oncologic Outcomes Following Partial Nephrectomy and Percutaneous Ablation for cT1 Renal Masses. Eur Urol 2019, 76, 244–251.
Kitley, W.; Sulek, J. Treatment Trends and Long-Term Survival Associated with Cryotherapy and Partial Nephrectomy for Small Renal Masses in the National Cancer Database Using Propensity Score Matching. J Endourol. 2019, 33, 408-414.
Kandasami, S.V.; Mamoulakis, C. Impact of case volume on outcomes of ureteroscopy for ureteral stones: the clinical research office of the endourological society ureteroscopy global study. Eur Urol 2014, 66, 1046- 51.
Atwell, T.D.; Farrell MA, Callstrom MR, et al. Percutaneous cryoablation of 40 solid renal tumors with US guidance and CT monitoring: initial experience. Radiology 2007; 243:276 –283 DOI: https://doi.org/10.1148/radiol.2431052133
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