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Pickersgill NA, Vetter JM, Kim EH, Cope SJ, Du K, Venkatesh R, Giardina JD, Saad NES, Bhayani SB, Figenshau RS. Ten-Year Experience with Percutaneous Cryoablation of Renal Tumors: Tumor Size Predicts Disease Progression. J Endourol 2020; 34:1211-1217. [PMID: 32292059 DOI: 10.1089/end.2019.0882] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
Introduction: Percutaneous cryoablation (PCA) has emerged as an alternative to extirpative management of small renal masses (SRMs) in select patients, with a reduced risk of perioperative complications. Although disease recurrence is thought to occur in the early postoperative period, limited data on long-term oncologic outcomes have been published. We reviewed our 10-year experience with PCA for SRMs and assessed predictors of disease progression. Materials and Methods: We reviewed our prospectively maintained database of patients who underwent renal PCA from March 2005 to December 2015 (n = 308). Baseline patient and tumor variables were recorded, and postoperative cross-sectional imaging was examined for evidence of disease recurrence. Disease progression was defined as the presence of local recurrence or new lymphadenopathy/metastasis. Results: Mean patient age was 67.2 ± 11 years, mean tumor size was 2.7 ± 1.3 cm, and mean nephrometry score was 6.8 ± 1.7. At mean follow-up of 38 months, local recurrence and new lymphadenopathy/metastasis occurred in 10.1% (31/308) and 6.2% (19/308) of patients, respectively. Excluding patients with a solitary kidney and/or von Hippel-Lindau, local recurrence and new lymphadenopathy/metastasis occurred in 8.6% (23/268) and 1.9% (5/268) of cases, respectively. Kaplan-Meier estimated disease-free survival was 92.5% at 1 year, 89.3% at 2 years, and 86.7% at 3 years post-PCA. Increasing tumor size was a significant predictor of disease progression (hazard ratio 1.32 per 1-cm increase in size, p = 0.001). Conclusions: PCA is a viable treatment option for patients with SRMs. Increasing tumor size is a significant predictor of disease progression following PCA.
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Affiliation(s)
- Nicholas A Pickersgill
- Division of Urologic Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Joel M Vetter
- Division of Urologic Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Eric H Kim
- Division of Urologic Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Sky J Cope
- University of Missouri-Kansas City School of Medicine, Kansas City, Missouri, USA
| | - Kefu Du
- Division of Urologic Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Ramakrishna Venkatesh
- Division of Urologic Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Joseph Daniel Giardina
- Division of Interventional Radiology, Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Nael E S Saad
- Division of Interventional Radiology, Department of Radiology, University of Rochester Medical Center, Rochester, New York, USA
| | - Sam B Bhayani
- Division of Urologic Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Robert S Figenshau
- Division of Urologic Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, Missouri, USA
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Papa M, Suardi N, Losa A, Agostini G, Maga T, Ierardi AM, Carrafiello G, Gaboardi F, Cardone G. ABLATE: a score to predict complications and recurrence rate in percutaneous treatments of renal lesions. Med Oncol 2020; 37:26. [PMID: 32166542 DOI: 10.1007/s12032-020-01351-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Accepted: 02/26/2020] [Indexed: 01/20/2023]
Abstract
RENAL score has been validated on predicting adverse events and relapses in percutaneous treatments of renal lesions. To better fit interventional issues a modified score (mRENAL) has been introduced, but the only difference from the RENAL score is on the dimensional parameter. However, it remains of surgical derivation while a specific interventional score is missing. This study aims to obtain a specific score (ABLATE) to better quantify the risk of complications and relapses in percutaneous kidney ablation procedures compared to the existing surgical scores. Taking inspiration from previous papers, a score was built to quantify the real difficulties faced in percutaneous treatment of renal lesions. The ABLATE score was used on 71 cryoablations to evaluate its predictivity of complications and relapses. Logistic regression was used to predict complication incidence; Cox-regression was used for relapses; ROC analysis was used to evaluate the accuracy of the different scores. Between January 2014 and November 2019, 71 lesions in 68 patients were treated. Overall, malignant histology was found in 62 lesions (87.3%). Mean and median RENAL, mRENAL, and ABLATE scores were 7.04 and 7, 7.19 and 7, and 5.11 and 4, respectively. Out of 71 treatments, we experienced 3 bleeding with anemia (4.2%), only 2 of which needed further treatment (2.82%). The mean and median RENAL, mRENAL, and ABLATE scores in those with complications were 7.66 and 7.01 (p = 0.69), 8.0 and 7.1 (p = 0.54), and 6.6 and 5.0 (p = 0.38), respectively. Out of 62 malignant lesions, we experienced 2 persistent and 6 recurrent lesions (3.2% and 8.4%, respectively). At Cox-regression analyses, mABLATE score outperformed both RENAL and mRENAL scores in predicting recurrences (HR 1.48; p < 0.001 vs. 1.41; p = 0.1 vs. 1.38: p = 0.07, respectively). The ABLATE score showed to be a better predictor of relapses than RENAL and mRENAL. The small number of complications conditioned a lack of statistic power on complications for all the scores. At the moment to quantify the risks in percutaneous kidney ablation procedures, surgical scores are used. A specific score better performs this task.
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Affiliation(s)
- Maurizio Papa
- Ospedale San Raffaele Sede di Ville Turro - UOC Radiology, Milan, Italy.
| | - Nazareno Suardi
- Ospedale San Raffaele Sede di Ville Turro - UOC Urology, Milan, Italy
| | - Andrea Losa
- Ospedale San Raffaele Sede di Ville Turro - UOC Urology, Milan, Italy
| | - Giulia Agostini
- Ospedale San Raffaele Sede di Ville Turro - UOC Radiology, Milan, Italy
| | - Tommaso Maga
- Ospedale San Raffaele Sede di Ville Turro - UOC Urology, Milan, Italy
| | | | | | - Franco Gaboardi
- Ospedale San Raffaele Sede di Ville Turro - UOC Urology, Milan, Italy
| | - Gianpiero Cardone
- Ospedale San Raffaele Sede di Ville Turro - UOC Radiology, Milan, Italy
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Alsaikhan N, Alshehri W, Cassidy F, Aganovic L, Vahdat N. Renal tumor structured reporting including nephrometry score and beyond: what the urologist and interventional radiologist need to know. Abdom Radiol (NY) 2019; 44:190-200. [PMID: 29980830 DOI: 10.1007/s00261-018-1691-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
The purpose of this paper is to describe cross-sectional imaging anatomic and morphologic parameters of solid renal tumors that urologists and interventional radiologists need for precise management, review the commonly used terms and descriptors of those parameters, and suggest a comprehensive reporting system for detected masses.
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Affiliation(s)
- Naif Alsaikhan
- Department of Radiology, University of California, San Diego, USA
| | - Wael Alshehri
- Department of Radiology, University of California, San Diego, USA.
| | - Fiona Cassidy
- Department of Radiology, University of California, San Diego, USA
- Division of Body Imaging, Department of Radiology, VA Healthcare System, San Diego, USA
| | - Lejla Aganovic
- Department of Radiology, University of California, San Diego, USA
- Division of Body Imaging, Department of Radiology, VA Healthcare System, San Diego, USA
| | - Noushin Vahdat
- Department of Radiology, University of California, San Diego, USA
- Division of Body Imaging, Department of Radiology, VA Healthcare System, San Diego, USA
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4
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Makki A, Graumann O, Høyer S, Solvig J, Østraat Ø, Madsen MG, Nielsen TK. Cryoablation of Renal Angiomyolipoma: An Evaluation of Safety and Efficacy. J Endourol 2017; 31:1117-1122. [PMID: 28830229 DOI: 10.1089/end.2017.0376] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Small series have reported that cryoablation (CA) is a safe and feasible minimally invasive nephron-sparing alternative for the treatment of renal angiomyolipomas (renal AMLs). The aim of the present study was to investigate the safety and efficacy of CA in patients with renal AML. MATERIALS AND METHODS A retrospective review of 19 renal AML lesions treated with CA at Aarhus University Hospital, Denmark, over a 5-year period. RESULTS The treatment was performed as laparoscopy-assisted CA on 7 lesions, and in the remaining 12 lesions CA was performed as a percutaneous ultrasound-guided CA. The mean patient age was 46 years [interquartile range (IQR) 30] and the mean tumor volume was 50.1 cm3 (IQR 53.3). In all cases, the procedure was effectively conducted with no conversion to open surgery, and no major complications were experienced. The mean follow-up time was 25 months (IQR 13). Mean maximum tumor volume was reduced from 50.1 cm3 (IQR 53.3) to 12.2 cm3 (IQR 14.1), p = 0.05. No patients presented with retroperitoneal hemorrhage or recurrence during follow-up. CONCLUSION Treating renal AMLs with CA appears to be a safe and effective nephron-sparing approach and could be a valuable alternative to other treatment modalities. The low complication rate, absence of retreatment and a good preservation of renal function might allow treatment of even subclinical renal AMLs to minimize the risk of potentially life-threatening hemorrhage.
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Affiliation(s)
- Ahmad Makki
- 1 Department of Urology, Aarhus University Hospital , Aarhus, Denmark
| | - Ole Graumann
- 2 Department of Radiology, Odense University Hospital , Odense, Denmark
| | - Søren Høyer
- 3 Department of Pathology, Aarhus University Hospital , Aarhus, Denmark
| | - Jan Solvig
- 4 Department of Radiology, Aarhus University Hospital , Aarhus, Denmark
| | - Øyvind Østraat
- 1 Department of Urology, Aarhus University Hospital , Aarhus, Denmark
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Prins FM, Kerkmeijer LGW, Pronk AA, Vonken EJPA, Meijer RP, Bex A, Barendrecht MM. Renal Cell Carcinoma: Alternative Nephron-Sparing Treatment Options for Small Renal Masses, a Systematic Review. J Endourol 2017; 31:963-975. [PMID: 28741377 DOI: 10.1089/end.2017.0382] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND The standard treatment of T1 renal cell carcinoma (RCC) is (partial) nephrectomy. For patients where surgery is not the treatment of choice, for example in the elderly, in case of severe comorbidity, inoperability, or refusal of surgery, alternative treatment options are available. These treatment options include active surveillance (AS), radiofrequency ablation (RFA), cryoablation (CA), microwave ablation (MWA), or stereotactic body radiotherapy (SBRT). In the present overview, the efficacy, safety, and outcome of these different options are summarized, particularly focusing on recent developments. MATERIALS AND METHODS Databases of MEDLINE (through PubMed), EMBASE, and the Cochrane Library were systematically searched according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) criteria. The search was performed in December 2016, and included a search period from 2010 to 2016. The terms and synonyms used were renal cell carcinoma, active surveillance, radiofrequency ablation, microwave ablation, cryoablation and stereotactic body radiotherapy. RESULTS The database search identified 2806 records, in total 73 articles were included to assess the rationale and clinical evidence of alternative treatment modalities for small renal masses. The methodological quality of the included articles varied between level 2b and level 4. CONCLUSION Alternative treatment modalities, such as AS, RFA, CA, MWA, and SBRT, are treatment options especially for those patients who are unfit to undergo an invasive treatment. There are no randomized controlled trials available comparing surgery and less invasive modalities, leading to a low quality on the reported articles. A case-controlled registry might be an alternative to compare outcomes of noninvasive treatment modalities in the future.
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Affiliation(s)
- Fieke M Prins
- 1 Department of Radiation Oncology, University Medical Center Utrecht , Utrecht, The Netherlands
| | - Linda G W Kerkmeijer
- 1 Department of Radiation Oncology, University Medical Center Utrecht , Utrecht, The Netherlands
| | - Anne A Pronk
- 2 Department of Urology, Tergooi Hospital , Hilversum, The Netherlands
| | - Evert-Jan P A Vonken
- 3 Department of Radiology, University Medical Center Utrecht , Utrecht, The Netherlands
| | - Richard P Meijer
- 4 Department of Urology, University Medical Center Utrecht , Utrecht, The Netherlands
| | - Axel Bex
- 5 Department of Urology, The Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital , Amsterdam, The Netherlands
| | - Maurits M Barendrecht
- 6 Department of Urology, Tergooi Hospital, Hilversum and University Medical Center Utrecht , Utrecht, The Netherlands
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Skin-to-tumor Distance Predicts Treatment Failure of T1A Renal Cell Carcinoma Following Percutaneous Cryoablation. Urology 2017; 108:195-200. [PMID: 28652159 DOI: 10.1016/j.urology.2017.06.026] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2017] [Revised: 06/01/2017] [Accepted: 06/14/2017] [Indexed: 01/20/2023]
Abstract
OBJECTIVE To determine the impact of skin-to-tumor (STT) distance on the risk for treatment failure following percutaneous cryoablation (PCA). METHODS We retrospectively reviewed patients who underwent PCA with documented T1a recurrent renal cell carcinoma (RCC) at 2 academic centers between 2005 and 2015. Patient demographics, tumor characteristics, and perioperative and postoperative course variables were collected. Additionally, we measured the STT distance by averaging the distance from the skin to the center of the tumor at 0°, 45°, and 90° on preoperative computed tomography imaging. RESULTS We identified 86 patients with documented T1a RCC. The mean age at the time of surgery was 69 years (range: 37-91 years), and the mean tumor size was 2.7 cm (range: 1.0-4.0 cm). With a mean follow-up of 24 months (range: 3-63 months), 11 (12.8%) treatment failures occurred. Patients with treatment failure had significantly higher mean STT distance than those without: 11.0 cm (range: 6.3-20.1 cm) compared to 8.4 cm (range: 4.4-15.2 cm), respectively (P = .002). STT distance was an independent predictor of treatment failure (odds ratio: 1.32, 95% confidence interval: 1.04-1.69, P = .029). STT distance greater than 10 cm had a fourfold increased risk of tumor treatment failure (odds ratio: 4.43, 95% confidence interval: 1.19-16.39, P = .018). Tumor size, R.E.N.A.L. Nephrometry score, and number of cryoprobes placed were not associated with treatment failure. CONCLUSION STT, an easily measured preoperative variable, may inform the risk of RCC treatment failure following PCA.
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7
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Mouli SK, McDevitt JL, Su YK, Ragin AB, Gao Y, Nemcek AA, Lewandowski RJ, Salem R, Sato KT. Analysis of the RENAL and mRENAL Scores and the Relative Importance of Their Components in the Prediction of Complications and Local Progression after Percutaneous Renal Cryoablation. J Vasc Interv Radiol 2017; 28:860-867. [DOI: 10.1016/j.jvir.2016.12.1224] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2016] [Revised: 12/25/2016] [Accepted: 12/26/2016] [Indexed: 01/20/2023] Open
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Bertolotto M, Siracusano S, Cicero C, Iannelli M, Silvestri T, Celia A, Guarise A, Stacul F. Cryotherapy of Renal Lesions: Enhancement on Contrast-Enhanced Sonography on Postoperative Day 1 Does Not Imply Viable Tissue Persistence. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2017; 36:301-310. [PMID: 27914172 DOI: 10.7863/ultra.16.02061] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/20/2016] [Accepted: 05/23/2016] [Indexed: 06/06/2023]
Abstract
OBJECTIVES To investigate whether persistent enhancement detected on contrast-enhanced sonography at postoperative day 1 (early contrast-enhanced sonography) after cryoablation of renal tumors implies the presence of residual viable tumor tissue, defined as residual enhancing tissue on reference imaging (computed tomography or magnetic resonance imaging) performed 6 months after the procedure. METHODS Seventy-four patients with percutaneous cryoablation of renal tumors had early contrast-enhanced sonography from November 2011 to August 2015. Two independent readers evaluated early contrast-enhanced sonographic findings and contrast-enhanced sonographic investigations performed 1 month after cryoablation of lesions that displayed enhancement on early contrast-enhanced sonography. They scored intralesional enhancement in 4 groups: no enhancement, few intralesional vessels, focal enhancing areas, and diffuse enhancement. Inter-reader agreement in evaluating lesion vascularity on early contrast-enhanced sonography was assessed with weighted κ statistics. Computed tomography or magnetic resonance imaging performed 6 months after the treatment was the reference procedure for assessing the absence or presence of residual disease. RESULTS Inter-reader agreement in assessing intratumoral vascularization on early contrast-enhanced sonography was very good (κ = 0.90). Enhancement was absent for both readers in 33 of 74 cases; only a few intralesional vessels were visible in 21; whereas diffuse or focal enhancement was present in 13. In the remaining 7 patients, there were differences. Four lesions with focal enhancement on early contrast-enhanced sonography and 1 that was considered avascular had residual tumors on reference imaging. Ablation was successful in the remaining 69 of 74 patients (93%). CONCLUSIONS After cryoablation, intratumoral enhancement on early contrast-enhanced sonography does not imply tumor cell viability.
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Affiliation(s)
- Michele Bertolotto
- Department of Radiology, University of Trieste, Ospedale di Cattinara, Trieste, Italy
| | - Salvatore Siracusano
- Department of Urology, University of Verona, Policlinico G. B. Rossi, Verona, Italy
| | - Calogero Cicero
- Department of Radiology, Ospedale San Bassiano, Bassano del Grappa, Italy
| | - Mariano Iannelli
- Department of Radiology, University of Trieste, Ospedale di Cattinara, Trieste, Italy
| | - Tommaso Silvestri
- Department of Urology, University of Trieste, Ospedale di Cattinara, Trieste, Italy
| | - Antonio Celia
- Department of Urology, Ospedale San Bassiano, Bassano del Grappa, Italy
| | - Alessandro Guarise
- Department of Radiology, Ospedale San Bassiano, Bassano del Grappa, Italy
| | - Fulvio Stacul
- S. C. Radiologia Ospedale Maggiore, Azienda Ospedaliero-Universitaria Ospedali Riuniti di Trieste, Trieste, Italy
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Okhunov Z, Moreira DM, del Junco M, Abedi G, Lobko II, Kaler KS, Nguyen ND, Youssef R, Uchio E, Kavoussi LR, Landman J. Predictors of Complications After Percutaneous Image-Guided Renal Cryoablation for T1a Renal Cortical Neoplasms. J Endourol 2017; 31:7-13. [DOI: 10.1089/end.2016.0684] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Affiliation(s)
- Zhamshid Okhunov
- Department of Urology, University of California, Irvine, Orange, California
| | | | - Michael del Junco
- Department of Urology, University of California, Irvine, Orange, California
| | - Garen Abedi
- Department of Urology, University of California, Irvine, Orange, California
| | - Igor I. Lobko
- The Arthur Smith Institute for Urology, Hofstra North Shore-LIJ School of Medicine, Hempstead, New York
| | - Kamaljot S. Kaler
- Department of Urology, University of California, Irvine, Orange, California
| | - Nobel D. Nguyen
- Department of Urology, University of California, Irvine, Orange, California
| | - Ramy Youssef
- Department of Urology, University of California, Irvine, Orange, California
| | - Edward Uchio
- Department of Urology, University of California, Irvine, Orange, California
| | - Louis R. Kavoussi
- The Arthur Smith Institute for Urology, Hofstra North Shore-LIJ School of Medicine, Hempstead, New York
| | - Jaime Landman
- Department of Urology, University of California, Irvine, Orange, California
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Kuusk T, Biancari F, Lane B, Tobert C, Campbell S, Rimon U, D'Andrea V, Mehik A, Vaarala MH. Treatment of renal angiomyolipoma: pooled analysis of individual patient data. BMC Urol 2015; 15:123. [PMID: 26710923 PMCID: PMC4693425 DOI: 10.1186/s12894-015-0118-2] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2015] [Accepted: 12/22/2015] [Indexed: 11/24/2022] Open
Abstract
Background This study was performed to evaluate the impact of baseline characteristics and treatment methods on the outcome of sporadic renal angiomyolipoma (AML). Methods This was a pooled analysis of individual data of 441 patients with AML retrieved from 58 studies and 3 institutional series. Results Ninety-three patients underwent nephrectomy, 163 partial nephrectomy/enucleation, 128 embolisation, 19 cryoablation, 6 radiofrequency ablation, and 32 conservative treatment. Their mean follow-up period was 44.5 months. Patients who experienced major bleeding at presentation had significantly larger tumours than did those without bleeding (mean diameter, 10.1 vs. 5.9 cm, respectively; p < 0.0001). A total of 9.4 % and 26.4 % of bleeding tumours had a diameter of <4 and <6 cm, respectively. A tumour diameter of ≥8.0 cm (hazard ratio, 2.07; 95 % confidence interval, 1.20–4.77) and the treatment method (p = 0.001) were independent predictors of re-intervention. The risk of re-intervention was significantly higher after embolisation, particularly for large tumours (5-year rate of freedom from re-intervention: diameter of ≥8.0 cm, 49.2 %; diameter of <8.0 cm, 74.8 %; p = 0.018). Conservatively treated AMLs had a mean baseline diameter of 3.2 ± 2.7 cm; after 41 months, their mean diameter was 3.7 ± 3.1 cm (p = 0.109). Conclusions The prevalence of major bleeding is high in sporadic AMLs with a diameter of >6 cm. These results suggest that conservative treatment can be considered in AMLs of <6 cm in diameter. Among current treatment methods, embolisation was associated with a significantly higher risk of re-intervention. Further studies are needed to define risk factors for bleeding and assess the relative benefits of different treatment modalities.
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Affiliation(s)
- Teele Kuusk
- Department of Surgery and Medical Research Center Oulu, Oulu University Hospital and University of Oulu, PO Box 21, 90029 OYS, Oulu, Finland.
| | - Fausto Biancari
- Department of Surgery and Medical Research Center Oulu, Oulu University Hospital and University of Oulu, PO Box 21, 90029 OYS, Oulu, Finland.
| | - Brian Lane
- Division of Urology, Michigan State University, Grand Rapids, Michigan, USA.
| | - Conrad Tobert
- Division of Urology, Michigan State University, Grand Rapids, Michigan, USA.
| | - Steven Campbell
- Department of Urology, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio, USA.
| | - Uri Rimon
- Sheba Medical Center, Tel-Hashomer, Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel.
| | - Vito D'Andrea
- Department of Surgery and Medical Research Center Oulu, Oulu University Hospital and University of Oulu, PO Box 21, 90029 OYS, Oulu, Finland.
| | - Aare Mehik
- Department of Surgery and Medical Research Center Oulu, Oulu University Hospital and University of Oulu, PO Box 21, 90029 OYS, Oulu, Finland.
| | - Markku H Vaarala
- Department of Surgery and Medical Research Center Oulu, Oulu University Hospital and University of Oulu, PO Box 21, 90029 OYS, Oulu, Finland.
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11
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Yan X, Zhang M, Chen X, Wei W, Yang R, Yang Y, Gan W, Guo H, Wang Y, Shi GP. Image-guided percutaneous renal cryoablation for stage 1 renal cell carcinoma with high surgical risk. World J Surg Oncol 2015; 13:200. [PMID: 26059547 PMCID: PMC4468960 DOI: 10.1186/s12957-015-0610-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2014] [Accepted: 05/22/2015] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND This study was undertaken to evaluate the feasibility, safety, and therapeutic effects of percutaneous renal cryoablation under local anesthesia with conscious sedation for patients who have unresectable stage 1 (T1NoMo) renal cell carcinoma (RCC) in high surgical risk. METHODS Eighteen patients who were not candidates for surgery underwent primary cryosurgery guided by gray-scale ultrasound. Contrast-enhanced ultrasonography (CEUS) and contrast-enhanced computed tomography (CT) were performed to evaluate treatment at completion. RESULTS The mean follow-up period was 26.8 months (range, 12-56 months). All tumors were biopsied before cryosurgery. Seventeen tumors remained free of enhancement during follow-up period. No major complications associated with cryoablation procedures were found though two instances of subcapsular hematomas, one of retroperitoneal errhysis and one of nausea, were seen after cryoablation. One patient had a local recurrence of tumor and received additional cryoablation. Local tumor control rate was 100 % of T1NoMo tumors including the recurrence case who underwent additional cryoablation. CONCLUSIONS Percutaneous cryoablation can be recommended as a feasible, safe, and promising therapy for the treatment of renal tumor, especially those unresectable stage 1 RCC, with a low risk of complications.
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Affiliation(s)
- Xiang Yan
- Department of Urology, Affiliated Nanjing Drum Tower Hospital, Medical School of Nanjing University, Nanjing, China.
| | - Mingxin Zhang
- Department of Urology, Affiliated Nanjing Drum Tower Hospital, Medical School of Nanjing University, Nanjing, China.
| | - Xiaoxiang Chen
- Department of Urology, Affiliated Nanjing Drum Tower Hospital, Medical School of Nanjing University, Nanjing, China.
| | - Wang Wei
- Department of Urology, Affiliated Nanjing Drum Tower Hospital, Medical School of Nanjing University, Nanjing, China.
| | - Rong Yang
- Department of Urology, Affiliated Nanjing Drum Tower Hospital, Medical School of Nanjing University, Nanjing, China.
| | - Yang Yang
- Department of Urology, Affiliated Nanjing Drum Tower Hospital, Medical School of Nanjing University, Nanjing, China.
| | - Weidong Gan
- Department of Urology, Affiliated Nanjing Drum Tower Hospital, Medical School of Nanjing University, Nanjing, China.
| | - Hongqian Guo
- Department of Urology, Affiliated Nanjing Drum Tower Hospital, Medical School of Nanjing University, Nanjing, China.
| | - Yang Wang
- Department of Radiology, Affiliated Nanjing Drum Tower Hospital, Medical School of Nanjing University, Nanjing, China.
| | - Guo-Ping Shi
- Medical School of Nanjing University, Nanjing, China. .,Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, USA.
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12
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Lang EK, Zhang KK, Nguyen Q, Myers L, Allaf M, Colon I. Efficacy of percutaneous cryoablation of renal cell carcinoma in older patients with medical comorbidities: Outcome study in 70 patients. Can Urol Assoc J 2015; 9:E256-61. [PMID: 26029291 DOI: 10.5489/cuaj.2597] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
INTRODUCTION The aim of this study was to establish the efficacy of cryoablation for incidentally discovered small renal cell carcinomas in older patients with medical comorbidities. METHODS We carried out a retrospective chart analysis of outcomes of 70 patients treated by cryoablation. The inclusion criteria were age >56 years, medical comorbidities (Charlson class I-III), and suitability for cryoablation established by urologists and interventional radiologists. In total, 43 patients were male, 27 female, and the age range was 56 to 89. The lesions measured 1.5 to 4 cm; 29 were high-grade Fuhrman and 41 were low grade. All lesions were treated by 2 10-minute freezing cycles separated by an 8-minute thawing period. One to seven cryoprobes were inserted according to a preoperative, 3D computed tomography (CT)-based plan. RESULTS Results were assessed on follow-up CTs (at 8-9 months). Of the 70 patients, 68 were treated by cryoablations and surgical salvage procedures; these patients were free of disease for 23 to 72 months (mean 39). One patient experienced recurrence and the other was lost to follow-up. One or two cryoablations rendered 66 patients tumour-free and additional surgery rendered another 2 patients tumour-free. The location and configuration of the lesion affected outcomes. Of the 27 posterior lesions, there was 1 failure; of the postero-lateral lesions, there were 4 failures; of the anterior lesions, there were 5 lesions; finally of the 32 central or deep seated lesions, there were 9 failures. Implants with one and two cryoprobes had a high recurrence rate. Three major complications were managed by minor interventions. The mean hospitalization was 1.3 days and the procedure times were variable. CONCLUSION Percutaneous cryoablation is recommended as a minimally invasive nephron-sparing treatment for amenable lesions in older patients with medical comorbidities.
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Affiliation(s)
| | - Kan Karl Zhang
- Department of Surgery, Division of Urology, Duke University Medical Center, Durham, NC
| | | | | | | | - Ivan Colon
- SUNY Downstate Medical Center, Brooklyn, NY
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Babaian KN, Okhunov Z, Juncal S, Ordon M, Lusch A, Zand T, Andreoni C, Landman J. Clinical Outcomes of Patients With Nondiagnostic Biopsy During Cryoablation of Small Renal Masses. Urology 2015; 85:605-9. [DOI: 10.1016/j.urology.2014.11.016] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2014] [Revised: 11/11/2014] [Accepted: 11/20/2014] [Indexed: 10/23/2022]
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Rodríguez-Faba O, Palou J, Rosales A, de la Torre P, Martí J, Palazzetti A, Villavicencio H. Prospective study of ultrasound-guided percutaneous renal cryotherapy: case selection as an optimization factor for a technique. Actas Urol Esp 2015; 39:8-12. [PMID: 25124045 DOI: 10.1016/j.acuro.2014.03.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2013] [Revised: 03/05/2014] [Accepted: 03/31/2014] [Indexed: 10/24/2022]
Abstract
OBJECTIVE To evaluate the technical and oncological effectiveness of ultrasound-guided percutaneous renal cryotherapy (PRC) in a selected group of patients with renal cancer. MATERIAL AND METHODS We conducted a prospective study of 28 patients with posterior-facing T1a renal tumors with middle and inferior external borders. All patients underwent ultrasound-guided PRC. Follow-up was conducted with computed tomography at 1 month and then every 6 months, with a good result defined as the total absence of contrast incorporation. We performed a descriptive and survival study using the Kaplan-Meier estimator. RESULTS The 28 patients had a mean age (SD) of 68.3 (10.1) years, and the group underwent 28 procedures. The mean (SD) size of the tumors was 25.5 (7.5) mm, the mean nephrometry score was 1.41 (0.52) and the mean preoperative creatinine level was 133.5 (144.1) mmol/L. There were no intraoperative complications. In terms of postoperative complications, there was only 1 case (3.5%) of a skin lesion resulting from treating a tumor in a transplanted kidney (Clavien II). The median follow-up was 25 months, and the mean (SD) postoperative creatinine level was 135.5 (110.3) mmol/L. Two cases presented radiological recurrence (93% efficacy), with a mean time to recurrence of 12 and 19 months, respectively. There were no tumor-related deaths. CONCLUSIONS Our series (the largest on PRC in our country to date) shows that, with an appropriate selection of tumors, PRC is a safe technique with minimal morbidity. Ultrasonography enables the controlled performance of the procedure and saves the patient from radiation and reduces costs.
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Rodríguez-Faba O, Palou J, Rosales A, de la Torre P, Martí J, Palazzetti A, Villavicencio H. Prospective study of ultrasound-guided percutaneous renal cryotherapy: Case selection as an optimization factor for a technique. ACTA ACUST UNITED AC 2015. [DOI: 10.1016/j.acuroe.2014.11.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Okhunov Z, Juncal S, Ordon M, George AK, Lusch A, del Junco M, Nguyentat M, Lobko II, Kavoussi L, Landman J. Comparison of outcomes in patients undergoing percutaneous renal cryoablation with sedation vs general anesthesia. Urology 2014; 85:130-4. [PMID: 25440762 DOI: 10.1016/j.urology.2014.09.013] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2014] [Revised: 08/30/2014] [Accepted: 09/16/2014] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To compare the efficacy and safety of local anesthesia with conscious sedation (LACS) with general anesthesia (GA) in patients undergoing percutaneous renal cryoablation (PRC) for renal cortical neoplasms. METHODS We performed a retrospective review of patients undergoing PRC between 2003 and 2013. Patient demographics, tumor characteristics, and perioperative and postoperative follow-up data were recorded and analyzed. We compared 3 principal outcomes across the GA and LACS groups: anesthesia-related outcomes, treatment failure, and complications. RESULTS A total of 235 patients with available data were included. Of these, 82 underwent PRC under GA and 153 patients under LACS. The 2 groups were similar with regard to age, gender, body mass index, American Society of Anesthesiologists score, tumor features, preoperative serum creatinine level, and hematocrit value. The GA and LACS groups had a similar percentage of patients with biopsy-proven renal cell carcinoma (68.5% and 64.2%, respectively; P = .62). The mean follow-up time for GA and LACS was 37 and 21 months, respectively (P <.0001). The mean procedure time for GA was significantly longer compared with LACS (133 vs 102 minutes; P <.001), and the mean hospital stay was shorter under LACS (1.08 vs 1.95 days; P <.0001). There was no difference in immediate failure (0% and 1.9%; P = .051) or recurrences (11% and 3.9%, respectively; P = .051) between GA and LACS groups. There was no difference in intraoperative and postoperative treatment-related complications between the 2 groups. CONCLUSION PRC for small renal masses under LACS is effective and safe. PRC with LACS has the advantage of decreased procedure time and a shorter hospital stay.
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Affiliation(s)
- Zhamshid Okhunov
- Department of Urology, University of California, Irvine, Orange, CA
| | - Samuel Juncal
- Department of Urology, University of California, Irvine, Orange, CA
| | - Michael Ordon
- Department of Urology, University of California, Irvine, Orange, CA
| | - Arvin K George
- The Arthur Smith Institute for Urology, Hofstra North Shore-LIJ School of Medicine, New Hyde Park, NY
| | - Achim Lusch
- Department of Urology, University of California, Irvine, Orange, CA
| | | | | | - Igor I Lobko
- The Arthur Smith Institute for Urology, Hofstra North Shore-LIJ School of Medicine, New Hyde Park, NY
| | - Louis Kavoussi
- The Arthur Smith Institute for Urology, Hofstra North Shore-LIJ School of Medicine, New Hyde Park, NY
| | - Jaime Landman
- Department of Urology, University of California, Irvine, Orange, CA.
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Update on Cryoablation for Treatment of Small Renal Mass: Oncologic Control, Renal Function Preservation, and Rate of Complications. Curr Urol Rep 2014; 15:396. [DOI: 10.1007/s11934-014-0396-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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[Focal therapy in urology: kidney cancer]. Urologia 2014; 80:276-82. [PMID: 24419921 DOI: 10.5301/ru.2013.11659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/21/2013] [Indexed: 11/20/2022]
Abstract
Focal therapy has gained attention in the treatment of small renal masses (SRM). However, its use is limited due to scarce data on long-term outcomes. The availability of such data is significantly lower as compared to the relevant data on surgery outcomes. At the same time, minimally invasive surgery has seen the development of laparoscopic nephron-sparing surgery and, recently, robot-assisted surgery. Our purpose is to review the possibilities of treatment for SMR with particular attention on focal therapy. Clinical series and comprehensive reviews support safety and mid/long-term efficacy of renal cryoablation or radiofrequency ablation. Comparative studies and meta-analysis outlined oncological inferiority against partial nephrectomy in local tumor control. For smaller and more peripheral lesions, radiofrequency ablation showed best indications than cryoablation. There are significant demographic and tumor differences between patients treated by one or another approach. The correct indication for each treatment seems to be of key importance to achieve the best oncological and functional outcome. Open partial nephrectomy remains the gold standard treatment for PMR, but laparoscopic approaches have been showing similar results.
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Maurice MJ, Haaga JR, Nakamoto DA, Ponsky LE. Pneumodissection: an alternative protective technique for the percutaneous cryoablation of small renal masses. Urol Int 2013; 90:381-3. [PMID: 23594736 DOI: 10.1159/000346332] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2012] [Accepted: 11/26/2012] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Percutaneous cryoablation is an emerging treatment option for the small renal mass. It poses a risk of thermal injury to adjacent tissues, limiting its application. We describe pneumodissection, a novel technique for preventing thermal injury during percutaneous cryoablation. MATERIALS AND METHODS The cases of 4 patients who underwent percutaneous renal cryoablation and pneumodissection were retrospectively reviewed. RESULTS Pneumodissection mechanically separated four tumors from overlying bowel segments (mean distance 1.2 ± 0.4 cm), permitting successful cryoablation. There were no complications or recurrences with 7.5 months of follow-up. CONCLUSIONS Pneumodissection is a feasible displacement technique that facilitates percutaneous cryoablation in at-risk patients. Further study is warranted.
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Affiliation(s)
- Matthew J Maurice
- Center for Urologic Oncology & Minimally Invasive Therapies, Urology Institute, University Hospitals Case Medical Center, Case Western Reserve University School of Medicine, Cleveland, Ohio 44106, USA
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Jacob ZC, Rashewsky S, Reinsel RA, Bilfinger TV, Moore W. Anesthesia Management for Pulmonary Cryoablation. ACTA ACUST UNITED AC 2013. [DOI: 10.4236/ojanes.2013.34057] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Abstract
Thermoablation (TA) has become an increasingly popular treatment for small renal masses (SRMs). Although long-term outcomes are not currently reported, TA may have a role in being an alternative to radical or partial nephrectomy. This review gives a broad overview of TA and discusses current controversies in the field.
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Affiliation(s)
- Phillip H Abbosh
- Division of Urology, Department of Surgery, Washington University School of Medicine, St. Louis, Missouri
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Kim EH, Tanagho YS, Bhayani SB, Saad NE, Benway BM, Figenshau RS. Percutaneous cryoablation of renal masses: Washington University experience of treating 129 tumours. BJU Int 2012; 111:872-9. [DOI: 10.1111/j.1464-410x.2012.11432.x] [Citation(s) in RCA: 55] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Affiliation(s)
- Eric H. Kim
- Division of Urology; Washington University School of Medicine; Saint Louis MO USA
| | - Youssef S. Tanagho
- Division of Urology; Washington University School of Medicine; Saint Louis MO USA
| | - Sam B. Bhayani
- Division of Urology; Washington University School of Medicine; Saint Louis MO USA
| | - Nael E. Saad
- Department of Radiology; Washington University School of Medicine; Saint Louis MO USA
| | - Brian M. Benway
- Division of Urology; Washington University School of Medicine; Saint Louis MO USA
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Blute Jr ML, Okhunov Z, Moreira DM, George AK, Sunday S, Lobko II, Vira MA. Image-guided percutaneous renal cryoablation: preoperative risk factors for recurrence and complications. BJU Int 2012; 111:E181-5. [DOI: 10.1111/j.1464-410x.2012.11538.x] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
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Autorino R, Kaouk JH. Cryoablation for small renal tumors: Current status and future perspectives. Urol Oncol 2012; 30:S20-7. [DOI: 10.1016/j.urolonc.2011.10.012] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2011] [Revised: 10/24/2011] [Accepted: 10/28/2011] [Indexed: 10/28/2022]
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Abstract
Renal ablation (RA) is no longer used exclusively in patients with limited life expectancy. There are few studies reporting a minimum follow-up of 5 years. Biases and discrepancies within the literature are abundant. The outcomes of any series must be interpreted in the context of median follow-up time, reported tumor characteristics, ablation technique and training background of the practitioner, and the definition of tumor recurrence. The long-term oncologic efficacy of radiofrequency ablation (RFA) and cryoablation appear similar, although the percutaneous RFA technique may necessitate reablation in more cases. RA is associated with slightly higher rates of local recurrence compared to surgical excision.
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