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Allen DM, Babar T, GloryAkinduro O, Li M, Khudari HE, Gunn AJ. External validation of the ability of the mRENAL nephrometry score to identify patients at risk for major adverse events or local tumor recurrence after percutaneous renal cryoablation. Abdom Radiol (NY) 2024:10.1007/s00261-024-04498-z. [PMID: 39150544 DOI: 10.1007/s00261-024-04498-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2024] [Revised: 07/12/2024] [Accepted: 07/13/2024] [Indexed: 08/17/2024]
Abstract
PURPOSE The purpose of this study was to evaluate the ability of the mRENAL score to identify patients at risk of either major adverse events (AEs) and/or local tumor recurrence (LR) after percutaneous cryoablation (PCA) in an external patient population. METHODS Patient demographic data were recorded. The RENAL and mRENAL nephrometry scores were calculated. Clinical outcomes such as AEs, LR, cancer-specific survival (CSS), and overall survival (OS) were collected. AEs were classified according to SIR criteria. Continuous variables and categorical variables were analyzed using the Wilcoxon rank sum test and chi-square test, respectively. Logistic regression analysis was performed to identify variables associated with major AEs or LR. RESULTS The study included 207 patients (Males: n = 117 (56.5%)) with a mean age of 65.8 (± 11.2) years (range:27-90). Overall, the mean tumor diameter, RENAL score, and mean mRENAL score were 30.1 mm (± 11.4), 6.3 (± 1.7), and 6.8 (± 1.9), respectively. 14 patients (6.8%) and 13 patients (6.3%) experienced a major AE or LR after PCA, respectively. CSS and OS were 98.6% and 90.3%, respectively. For patients with major AEs after PCA, the mean tumor diameter (p < 0.0001), mean RENAL score (p = 0.03), and mean mRENAL score (p = 0.009) were all higher than those for patients without a major AE. Multi-variate regression analysis showed that only mean tumor diameter (p = 0.005) was predictive of a major AE. There were no statistically significant differences between patients with LR and patients without LR after PCA with regards to tumor size (p = 0.07), mean RENAL score (p = 0.32), or mean mRENAL score (p = 0.07). Multi-variate regression analysis showed that only mean tumor diameter (p = 0.01) was predictive of LR. CONCLUSION The mRENAL score did not accurately identify patients at risk for either major AEs or LR. Maximum tumor diameter alone was predictive of both major AEs and LR, and should be the primary focus during patient selection.
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Affiliation(s)
- David M Allen
- Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Tarik Babar
- Division of Vascular and Interventional Radiology, University of Alabama at Birmingham, 619 19th St S, NHB 623, Birmingham, AL, USA
| | | | - Mei Li
- Department of Internal Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Husameddin El Khudari
- Division of Vascular and Interventional Radiology, University of Alabama at Birmingham, 619 19th St S, NHB 623, Birmingham, AL, USA
| | - Andrew J Gunn
- Division of Vascular and Interventional Radiology, University of Alabama at Birmingham, 619 19th St S, NHB 623, Birmingham, AL, USA.
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Efthymiou E, Velonakis G, Charalampopoulos G, Mazioti A, Brountzos E, Kelekis N, Filippiadis D. Computed tomography-guided percutaneous microwave ablation for renal cell carcinoma: evaluating the performance of nephrometry scores. Eur Radiol 2023; 33:7388-7397. [PMID: 37318604 DOI: 10.1007/s00330-023-09774-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2022] [Revised: 04/22/2023] [Accepted: 05/14/2023] [Indexed: 06/16/2023]
Abstract
OBJECTIVES The purpose of the current study is to evaluate the performance of RENAL and mRENAL scores, in the prediction of oncological outcomes in patients treated with microwave ablation (MWA) for (T1) renal cell carcinomas (RCC). METHODS Institutional database retrospective research identified 76 patients with a biopsy-proven solitary T1a (84%) or T1b (16%) RCC; all patients underwent CT-guided MWA ablation. Tumor complexity was reviewed by calculating RENAL and mRENAL scores. RESULTS The majority of the lesions were exophytic (82.9%), with > 7 mm nearness to the collecting system (53.9%), located posteriorly (73.6%), and lower to polar lines (61.8%). Mean RENAL and mRENAL scores were 5.7 (SD = 1.9) and 6.1 (SD = 2.1) respectively. Progression rates were significantly higher with greater tumor size (> 4 cm), with < 4 mm nearness to the collecting system, for tumors crossing a polar line and with the anterior location. None of the above was associated with complications. RENAL and mRENAL scores were significantly higher in patients with incomplete ablation. The ROC analysis showed the significant prognostic ability of both RENAL and mRENAL scores for progression. In both scores, the optimal cut-off point was 6.5. Univariate Cox regression analysis for progression showed a hazard ratio of 7.73 for the RENAL score and 7.48 for the mRENAL score. CONCLUSION The results of the present study show that the risk of progression was higher in patients with RENAL and mRENAL score of > 6.5, in T1b tumors, close to the collective system (< 4 mm), crossing polar lines and anterior location. CLINICAL RELEVANCE STATEMENT CT-guided percutaneous MWA is a safe and effective technique for the treatment of T1a renal cell carcinomas. Different morphometric parameters of RCC tumors including RENAL and mRENAL score > 6.5, size, proximity to the collecting system, and crossing of polar lines impact the efficacy of MWA and progression survival rates. KEY POINTS • The risk of progression is higher in patients with RENAL and mRENAL score > 6.5, in T1b tumors, close to the collective system (< 4 mm), crossing polar lines and anterior location. • The significant prognostic ability of the mRENAL score for progression was higher than the respective of the RENAL score. • Complications were not associated with any of the above factors.
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Affiliation(s)
- Evgenia Efthymiou
- Second Department of Radiology, University General Hospital ATTIKON, National and Kapodistrian University of Athens, Rimini 1, 12462, Athens, Greece.
| | - Georgios Velonakis
- Second Department of Radiology, University General Hospital ATTIKON, National and Kapodistrian University of Athens, Rimini 1, 12462, Athens, Greece
| | - Georgios Charalampopoulos
- Second Department of Radiology, University General Hospital ATTIKON, National and Kapodistrian University of Athens, Rimini 1, 12462, Athens, Greece
| | - Argyro Mazioti
- Second Department of Radiology, University General Hospital ATTIKON, National and Kapodistrian University of Athens, Rimini 1, 12462, Athens, Greece
| | - Elias Brountzos
- Second Department of Radiology, University General Hospital ATTIKON, National and Kapodistrian University of Athens, Rimini 1, 12462, Athens, Greece
| | - Nikolaos Kelekis
- Second Department of Radiology, University General Hospital ATTIKON, National and Kapodistrian University of Athens, Rimini 1, 12462, Athens, Greece
| | - Dimitrios Filippiadis
- Second Department of Radiology, University General Hospital ATTIKON, National and Kapodistrian University of Athens, Rimini 1, 12462, Athens, Greece
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Klein C, Cazalas G, Margue G, Piana G, DE Kerviler E, Gangi A, Puech P, Nedelcu C, Grange R, Buy X, Michiels C, Jegonday MA, Rouviere O, Grenier N, Marcelin C, Bernhard JC. Percutaneous tumor ablation versus image guided robotic-assisted partial nephrectomy for cT1b renal cell carcinoma: a comparative matched-pair analysis (UroCCR 80). Minerva Urol Nephrol 2023; 75:559-568. [PMID: 37728492 DOI: 10.23736/s2724-6051.23.05274-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/21/2023]
Abstract
BACKGROUND Partial nephrectomy (PN) is the gold standard treatment for cT1b renal tumors. Percutaneous guided thermal ablation (TA) has proven oncologic efficacy with low morbidity for the treatment of small renal masses (<3 cm). Recently, 3D image-guided robot-assisted PN (3D-IGRAPN) has been described, and decreased perioperative morbidity compared to standard RAPN has been reported. Our objective was to compare two minimally invasive image-guided nephron-sparing procedures (TA vs. 3D-IGRAPN) for the treatment of cT1b renal cell carcinomas (4.1-7 cm). METHODS Patients treated with TA and 3D-IGRAPN for cT1b renal cell carcinoma, prospectively included in the UroCCR database (NCT03293563), were pair-matched for tumor size, pathology, and RENAL score. The primary endpoint was the local recurrence rate between the two groups. Secondary endpoints included metastatic evolution, perioperative complications, decrease in renal function, and length of hospitalization. RESULTS A total of 198 patients were included and matched into two groups of 72 patients. The local recurrence rate was significantly higher in the TA group than that in the 3D-IGRAPN group (4.2% vs. 15.2%, P=0.04). Metastatic evolution and perioperative outcomes such as major complications, eGFR decrease, and length of hospitalization did not differ significantly between the two groups. CONCLUSIONS 3D-IGRAPN resulted in a significantly lower local recurrence rate and comparable rates of complications and metastatic evolution compared with thermal ablation.
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Affiliation(s)
- Clément Klein
- Department of Urology, Bordeaux Pellegrin University Hospital, Bordeaux, France -
| | - Grégoire Cazalas
- Department of Radiology, Bordeaux Pellegrin University Hospital, Bordeaux, France
| | - Gaëlle Margue
- Department of Urology, Bordeaux Pellegrin University Hospital, Bordeaux, France
| | - Gilles Piana
- Department of Radiology, Paoli-Calmettes Institute, Marseille, France
| | | | - Afshin Gangi
- Department of Interventional Radiology, Strasbourg University Hospital, Strasbourg, France
| | - Phillipe Puech
- Department of Radiology, Lille University Hospital, Lille, France
| | - Cosmina Nedelcu
- Department of Radiology, Angers University Hospital, Angers, France
| | - Remi Grange
- Department of Radiology, Saint-Etienne University Hospital, Saint Etienne, France
| | - Xavier Buy
- Department of Interventional Radiology, Bergonié Institute, Bordeaux, France
| | - Clément Michiels
- Department of Urology, Bordeaux Pellegrin University Hospital, Bordeaux, France
| | | | | | - Nicolas Grenier
- Department of Radiology, Bordeaux Pellegrin University Hospital, Bordeaux, France
| | - Clément Marcelin
- Department of Radiology, Bordeaux Pellegrin University Hospital, Bordeaux, France
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Cazalas G, Klein C, Piana G, De Kerviler E, Gangi A, Puech P, Nedelcu C, Grange R, Buy X, Jegonday MA, Bigot P, Bensalah CK, Gaillard V, Pignot G, Paparel P, Badet L, Michiels C, Bernhard JC, Rouviere O, Grenier N, Marcelin C. A multicenter comparative matched-pair analysis of percutaneous tumor ablation and robotic-assisted partial nephrectomy of T1b renal cell carcinoma (AblatT1b study-UroCCR 80). Eur Radiol 2023; 33:6513-6521. [PMID: 37004570 DOI: 10.1007/s00330-023-09564-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Revised: 01/27/2023] [Accepted: 02/08/2023] [Indexed: 04/04/2023]
Abstract
OBJECTIVE Renal cell carcinomas represent the sixth- and tenth-most frequently diagnosed cancer in men and women. Recently, percutaneous-guided thermal ablations have proved to be as effective as partial nephrectomy and safer for treating small renal masses (i.e., < 3 cm). This study compared the perioperative and recurrence outcomes of percutaneous thermal ablation (TA) and robotic-assisted partial nephrectomy (RAPN) for the treatment of T1b renal cell carcinomas (4.1-7 cm). METHODS Retrospective data from 11 centers on the national database, between 2010 and 2020, included 81 patients treated with thermal ablation (TA) and 308 patients treated with RAPN for T1b renal cell carcinoma, collected retrospectively and matched for tumor size, histology results, and the RENAL score. TA included cryoablation and microwave ablation. Endpoints compared the rate between the two groups: local recurrence, metastases, complications, renal function decrease, and length of hospitalization. RESULTS After matching, 75 patients were included in each group; mean age was 76.6 (± 9) in the TA group and 61.1 (± 12) in the RAPN group, including 69.3% and 76% men respectively. The local recurrence (LR) rate was significantly higher in the TA group than in the PN group (14.6% vs 4%; p = 0.02). The LR rate was 20% (1/5) after microwave ablation, 11.1% (1/9) after radiofrequency ablation, and 14.7% (9/61) after cryoablation. The major complication rate (Clavien-Dindo ≥ 3) was higher following PN than after TA (5.3% vs 0%; p < 0.001). Metastases, eGFR decrease, and length of hospitalization did not differ significantly between the two groups. CONCLUSIONS The local recurrence rate was significantly higher after thermal ablation; however, thermal ablation resulted in significantly lower rates of complications. Thermal ablation and robotic-assisted partial nephrectomy are effective treatments for T1b renal cancer; however, the local recurrence rate was higher after thermal ablation. KEY POINTS • The local recurrence rate was significantly higher in the thermal ablation group than in the partial nephrectomy group. • The major complication rate (Clavien-Dindo ≥ 3) was higher following PN than after TA (5.3% vs. 0%; p < 0.001).
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Affiliation(s)
- Grégoire Cazalas
- Service d'imagerie diagnostique et thérapeutique de l'adulte, Hôpital Pellegrin, place Amélie-Raba-Léon, 33076, Bordeaux, France
| | - Clément Klein
- Service d'urologie, andrologie et transplantation rénale, Hôpital Pellegrin, place Amélie-Raba-Léon, 33076, Bordeaux, France
| | - Gilles Piana
- Department of Radiology, Institut Paoli-Calmettes, Marseille, France
| | - Eric De Kerviler
- Department of Radiology, Hôpital Saint-Louis 1, avenue Claude Vellefaux, 75010, Paris, France
| | - Afshin Gangi
- Department of Interventional Radiology, University Hospital of Strasbourg, Strasbourg, France
| | - Philippe Puech
- Department of Radiology CHU Lille, Radiology Department, Lille, France
| | - Cosmina Nedelcu
- Department of Radiology, University Hospital, CHU Angers, 4 rue Larrey, 49933, Angers, France
| | - Remi Grange
- Department of Radiology, CHU Nord Saint-Etienne Avenue Albert Raimond, Saint Etienne, France
| | - Xavier Buy
- Department of Interventional Radiology, Institut Bergonié, Bordeaux, France
| | | | - Pierre Bigot
- Department of Urology, University Hospital of Angers, Angers, France
| | | | - Victor Gaillard
- Department of Urology, University Hospital of Strasbourg, Strasbourg, France
| | - Géraldine Pignot
- Department of Urology, Institut Paoli-Calmettes, Marseille, France
| | - Philippe Paparel
- Service d'Urologie, Centre Hospitalier Lyon Sud, Pierre Bénite, France
| | - Lionel Badet
- Service d'Urologie, Hôpital Edouard Herriot, Lyon, France
| | - Clément Michiels
- Service d'urologie, andrologie et transplantation rénale, Hôpital Pellegrin, place Amélie-Raba-Léon, 33076, Bordeaux, France
| | - Jean Christophe Bernhard
- Service d'urologie, andrologie et transplantation rénale, Hôpital Pellegrin, place Amélie-Raba-Léon, 33076, Bordeaux, France
| | - Olivier Rouviere
- Department of Radiology - Pavillon B, Hôpital E. Herriot, 69003, Lyon, France
| | - Nicolas Grenier
- Service d'imagerie diagnostique et thérapeutique de l'adulte, Hôpital Pellegrin, place Amélie-Raba-Léon, 33076, Bordeaux, France
| | - Clément Marcelin
- Service d'imagerie diagnostique et thérapeutique de l'adulte, Hôpital Pellegrin, place Amélie-Raba-Léon, 33076, Bordeaux, France.
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Junker T, Duus L, Rasmussen BSB, Azawi N, Lund L, Nørgaard B, Gerke O, Graumann O. Partial Nephrectomy versus Percutaneous Cryoablation of Small Renal Cell Carcinomas: A Comparison of Adverse Events in a Prospective Multicenter Cohort Study. J Vasc Interv Radiol 2022; 33:1375-1383.e7. [PMID: 35842025 DOI: 10.1016/j.jvir.2022.07.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Revised: 06/26/2022] [Accepted: 07/05/2022] [Indexed: 12/15/2022] Open
Abstract
PURPOSE To assess and compare complications and readmissions after partial nephrectomy and percutaneous cryoablation of cT1 renal cell carcinoma (RCC). MATERIALS AND METHODS Patients treated for cT1 RCC between 2019 and 2021 were prospectively and consecutively enrolled. Complications recorded within 30 and 90 days were graded according to the Clavien-Dindo classification, and percutaneous cryoablation was graded according to the Society of Interventional Radiology classification of adverse events. Major complications were defined as complications with a grade of ≥3 based on the Clavien-Dindo classification. Readmission within 30 days was recorded. RESULTS The cohort included 86 partial nephrectomies and 104 cryoablations. The complication rate within 90 days was 23% after partial nephrectomy and cryoablation (P = .98), with major complication rates of 3% after partial nephrectomy and 10% after cryoablation (P = .15). The readmission rates were 14% and 11% after partial nephrectomy and cryoablation, respectively (P = .48). Double-J stents were associated with overall complications (odds ratio [OR], 9.88; 95% confidence interval [CI], 2.18-44.68; P = .003) and readmissions (OR, 5.39; 95% CI, 1.37-21.06; P = .015) after cryoablation. A high versus low radius-endophytic-nearness-anterior-location score (OR, 5.86; 95% CI, 1.08-31.81; P = .040) and endophytic location (OR, 7.70; 95% CI, 1.72-34.50; P = .008) were associated with a higher complication rate after cryoablation. The Charlson Comorbidity Index (CCI) was associated with major complications after partial nephrectomy (OR, 2.12; 95% CI, 1.05-4.30; P = .036). CONCLUSIONS Partial nephrectomy and cryoablation are comparable regarding complications within 90 days after treatment. Tumor complexity and double-J stents were associated with complications after cryoablation, and a high CCI was associated with complications after partial nephrectomy.
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Affiliation(s)
- Theresa Junker
- Department of Radiology, Odense University Hospital, Odense, Denmark; Department of Clinical Research, University of Southern Denmark, Odense, Denmark; Research and Innovation Unit of Radiology, University of Southern Denmark, Odense, Denmark; Odense Patient data Explorative Network, University of Southern Denmark, Odense, Denmark; Department of Urology, University of Southern Denmark, Odense, Denmark.
| | - Louise Duus
- Department of Radiology, Odense University Hospital, Odense, Denmark; Department of Clinical Research, University of Southern Denmark, Odense, Denmark; Research and Innovation Unit of Radiology, University of Southern Denmark, Odense, Denmark; Odense Patient data Explorative Network, University of Southern Denmark, Odense, Denmark
| | - Benjamin S B Rasmussen
- Department of Radiology, Odense University Hospital, Odense, Denmark; Department of Clinical Research, University of Southern Denmark, Odense, Denmark; Research and Innovation Unit of Radiology, University of Southern Denmark, Odense, Denmark; Odense Patient data Explorative Network, University of Southern Denmark, Odense, Denmark
| | - Nessn Azawi
- Department of Urology, Zealand University Hospital, Roskilde, Denmark; Institute of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Lars Lund
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark; Department of Urology, University of Southern Denmark, Odense, Denmark
| | - Birgitte Nørgaard
- Department of Public Health, University of Southern Denmark, Odense, Denmark
| | - Oke Gerke
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark; Department of Nuclear Medicine, Odense University Hospital, Odense, Denmark
| | - Ole Graumann
- Department of Radiology, Odense University Hospital, Odense, Denmark; Department of Clinical Research, University of Southern Denmark, Odense, Denmark; Research and Innovation Unit of Radiology, University of Southern Denmark, Odense, Denmark; Odense Patient data Explorative Network, University of Southern Denmark, Odense, Denmark
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Song S, Yang Q, Gu C, Yu G, Hua B, Gu X, Wang L, Wang Z, Shi G, Xu B. Long-term outcomes of cryoablation for biopsy-proven T1 stage renal cell carcinoma. World J Surg Oncol 2022; 20:284. [PMID: 36064369 PMCID: PMC9446802 DOI: 10.1186/s12957-022-02752-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2022] [Accepted: 08/30/2022] [Indexed: 11/23/2022] Open
Abstract
Background To summarize our clinical experience of cryoablation in renal cell carcinoma (RCC) of Chinese population and to evaluate the long-term outcomes of laparoendoscopic single-site (LESS) cryoablation (LCA) as well as percutaneous CT-guided cryoablation (PCA) for biopsy-proven T1a and T1b RCC. Methods This was a multi-center, retrospective study investigating T1 stage RCC patients from 2011 to 2021. The patients were treated by LCA or PCA according to individual situation. Overall survival (OS), cancer-related survival (CSS), and progression-free survival (PFS) were evaluated for oncological outcomes, and kidney function, complications, and hospital stay were used to estimate technical outcomes. Results A total of 163 consecutive patients were included. Among them, 59 cases were treated by LCA and PCA was performed in 104 cases. All operations were processed successfully. Mean diameter of the mass was (2.9±1.4) cm; median blood volume was 45ml (10~200 ml). The mean operation time was 84.0 ± 24.5 min. The median postoperative hospital stay was 3 days (1~6 days). Compared with LCA, procedure time of PCA was shortened, the volume of bleeding was reduced, and the hospital stay was decreased. The overall adverse events rate was 9.8% (16/163). The mean preoperative and postoperative eGFR of LCA were 77.6±15.3 ml/min and 75.6±17.4 ml/min, respectively. Analogously, the values of PCA were 78.7±12.9 ml/min and 76.7±14.3 ml/min. Mean follow-up time was 64.2 ± 30.2 months (range, 7–127 months). Local recurrence was observed in 13 patients (8.0%), 4 (6.8%) cases of LCA and 9 (8.7%) cases of PCA. PFS at 5 and 10 years were 95.5% and 69.2% for LCA and 96.7% and 62.8% for PCA. In total, 26 patients (16.0%) (11 patients from LCA and 15 from PCA) died throughout the follow-up period. OS at 5 and 10 years were 93.8% and 31.4% for LCA, and 97.4% and 52.7% for PCA. Six patients (3.7%) (3 cases from LCA and 3 from PCA) died of metastatic RCC. CCS for LCA were 98.0% and 82.8% at 5 and 10 years, while the data were 100% and 86.4% for PCA. Conclusion LCA and PCA for T1 stage RCC provides satisfactory long-term oncological and renal function preservation outcomes, with acceptable complication rates.
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Affiliation(s)
- Shangqing Song
- Shanghai Ninth People's Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, 200011, China
| | - Qing Yang
- Shanghai Ninth People's Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, 200011, China
| | - Chengyuan Gu
- Fudan University Shanghai Cancer Center, Shanghai, 200032, China
| | - Guopeng Yu
- Shanghai Ninth People's Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, 200011, China
| | - Bao Hua
- Shanghai Ninth People's Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, 200011, China
| | - Xin Gu
- Shanghai Ninth People's Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, 200011, China
| | - Linhui Wang
- Shanghai Changhai Hospital, Naval Medical University, Shanghai, 200433, China
| | - Zhong Wang
- Shanghai Ninth People's Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, 200011, China
| | - Guohai Shi
- Fudan University Shanghai Cancer Center, Shanghai, 200032, China.
| | - Bin Xu
- Shanghai Ninth People's Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, 200011, China.
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Estimating the Individual Treatment Effect on Survival Time Based on Prior Knowledge and Counterfactual Prediction. ENTROPY 2022; 24:e24070975. [PMID: 35885198 PMCID: PMC9322711 DOI: 10.3390/e24070975] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Revised: 07/10/2022] [Accepted: 07/12/2022] [Indexed: 12/10/2022]
Abstract
The estimation of the Individual Treatment Effect (ITE) on survival time is an important research topic in clinics-based causal inference. Various representation learning methods have been proposed to deal with its three key problems, i.e., reducing selection bias, handling censored survival data, and avoiding balancing non-confounders. However, none of them consider all three problems in a single method. In this study, by combining the Counterfactual Survival Analysis (CSA) model and Dragonnet from the literature, we first propose a CSA–Dragonnet to deal with the three problems simultaneously. Moreover, we found that conclusions from traditional Randomized Controlled Trials (RCTs) or Retrospective Cohort Studies (RCSs) can offer valuable bound information to the counterfactual learning of ITE, which has never been used by existing ITE estimation methods. Hence, we further propose a CSA–Dragonnet with Embedded Prior Knowledge (CDNEPK) by formulating a unified expression of the prior knowledge given by RCTs or RCSs, inserting counterfactual prediction nets into CSA–Dragonnet and defining loss items based on the bounds for the ITE extracted from prior knowledge. Semi-synthetic data experiments showed that CDNEPK has superior performance. Real-world experiments indicated that CDNEPK can offer meaningful treatment advice.
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Yanagisawa T, Mori K, Kawada T, Motlagh RS, Mostafaei H, Quhal F, Laukhtina E, Rajwa P, Aydh A, König F, Pallauf M, Pradere B, Miki J, Kimura T, Egawa S, Shariat SF. Differential efficacy of ablation therapy versus partial nephrectomy between clinical T1a and T1b renal tumors: A systematic review and meta-analysis. Urol Oncol 2022; 40:315-330. [PMID: 35562311 DOI: 10.1016/j.urolonc.2022.04.002] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2021] [Revised: 02/21/2022] [Accepted: 04/06/2022] [Indexed: 10/18/2022]
Abstract
PURPOSE To assess the differential clinical outcomes of patients treated with partial nephrectomy (PN) vs. those treated with ablation therapy (AT) such as radiofrequency ablation, cryoablation and microwave ablation for cT1b compared to cT1a renal tumors. MATERIALS AND METHODS Multiple databases were searched for articles published before August 2021. Studies were deemed eligible if they compared clinical outcomes in patients who underwent PN with those who underwent AT for cT1a and/or cT1b renal tumors. RESULTS Overall, 27 studies comprising 13,996 patients were eligible for this meta-analysis. In both cT1a and cT1b renal tumors, there was no significant difference in the percent decline of estimated glomerular filtration rates or in the overall/severe complication rates between PN and AT. Compared to AT, PN was associated with a lower risk of local recurrence in both patients with cT1a and cT1b tumors (cT1a: pooled risk ratio [RR]; 0.43, 95% confidence intervals [CI]; 0.28-0.66, cT1b: pooled RR; 0.41, 95%CI; 0.23-0.75). Subgroup analyses regarding the technical approach revealed no statistical difference in local recurrence rates between percutaneous AT and PN in patients with cT1a tumors (pooled RR; 0.61, 95%CI; 0.32-1.15). In cT1b, however, PN was associated with a lower risk of local recurrence (pooled RR; 0.45, 95%CI; 0.23-0.88). There was no difference in distant metastasis or cancer mortality rates between PN and AT in patients with cT1a, or cT1b tumors. CONCLUSIONS AT has a substantially relevant disadvantage with regards to local recurrence compared to PN, particularly in cT1b renal tumors. Despite the limitations inherent to the nature of retrospective and unmatched primary cohorts, percutaneous AT could be used as a reasonable alternative treatment for well-selected patients with cT1a renal tumors.
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Affiliation(s)
- Takafumi Yanagisawa
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria; Department of Urology, The Jikei University School of Medicine, Tokyo, Japan
| | - Keiichiro Mori
- Department of Urology, The Jikei University School of Medicine, Tokyo, Japan
| | - Tatsushi Kawada
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria; Department of Urology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Reza Sari Motlagh
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria; Men's Health and Reproductive Health Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Hadi Mostafaei
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria; Research Center for Evidence Based Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Fahad Quhal
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria; Department of Urology, King Fahad Specialist Hospital, Dammam, Saudi Arabia
| | - Ekaterina Laukhtina
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria; Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia
| | - Pawel Rajwa
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria; Department of Urology, Medical University of Silesia, Zabrze, Poland
| | - Abdulmajeed Aydh
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria; Department of Urology, King Faisal Medical City, Abha, Saudi Arabia
| | - Frederik König
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria; Department of Urology, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Maximilian Pallauf
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria; Department of Urology, University Hospital Salzburg, Paracelsus Medical University Salzburg, Salzburg, Austria
| | - Benjamin Pradere
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - Jun Miki
- Department of Urology, The Jikei University School of Medicine, Tokyo, Japan
| | - Takahiro Kimura
- Department of Urology, The Jikei University School of Medicine, Tokyo, Japan
| | - Shin Egawa
- Department of Urology, The Jikei University School of Medicine, Tokyo, Japan
| | - Shahrokh F Shariat
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria; Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia; Hourani Center for Applied Scientific Research, Al-Ahliyya Amman University, Amman, Jordan; Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX; Department of Urology, Second Faculty of Medicine, Charles University, Prague, Czech Republic; Department of Urology, Weill Cornell Medical College, New York, NY; Karl Landsteiner Institute of Urology and Andrology, Vienna, Austria.
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Li S, Huang J, Jang S, Schammel NC, Schammel C, Som A, El Khudari H, Devane AM, Gunn AJ. Utility of the RENAL Nephrometry Scoring System in Predicting Adverse Events and Outcomes of Percutaneous Microwave Ablation of Renal Tumors. J Vasc Interv Radiol 2022; 33:695-701. [PMID: 35311666 DOI: 10.1016/j.jvir.2022.03.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Revised: 01/24/2022] [Accepted: 03/09/2022] [Indexed: 11/16/2022] Open
Abstract
PURPOSE To assess the utility of the radius, exophytic/endophytic, nearness to collecting system or sinus, anterior/posterior, and location relative to polar lines (RENAL) nephrometry scoring system at predicting adverse events and outcomes in percutaneous microwave ablation (MWA) of renal tumors. MATERIALS AND METHODS A retrospective review of 116 patients who underwent MWA from 2004 to 2018 at 2 large university hospitals was conducted. Patient demographics and tumor characteristics were collected. The RENAL nephrometry scores were calculated, and procedure-related adverse events were stratified into minor and major (the Society of Interventional Radiology classification of class C or higher). Technical and oncologic outcomes were based on follow-up magnetic resonance imaging and computed tomography scans after ablation. RESULTS The mean RENAL score was 6.6 (range, 4-11), and the mean tumor size was 24 mm. Follow-up ranged between 16 and 161 weeks (median, 50 weeks; mean, 65 weeks). Oncologic control was achieved in 96% (n = 111) of patients. The major and minor adverse event rates were 8.6% (n = 10) and 17% (n = 19), respectively. The mean RENAL score for patients with recurrent and/or residual tumor (8.2 ± 2.7) was higher than that for patients without disease recurrence (6.5 ± 3.5, P = .05). However, in a multivariate analysis, the RENAL score was not found to be an independent predictor of oncologic outcomes (odds ratio, 1.548; P = .092). CONCLUSIONS The RENAL nephrometry score has minimal utility for predicting outcomes and adverse events in MWA of renal tumors. The inconsistent nature of RENAL nephrometry scoring in percutaneous ablation procedures underscores the need for an ablation-specific risk stratification system.
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Affiliation(s)
- Sienna Li
- Harvard Medical School, Boston, Massachusetts.
| | - Junjian Huang
- Department of Radiology, University of Alabama School of Medicine, Birmingham, Alabama
| | - Sean Jang
- Boston University, Boston, Massachusetts
| | - Noah C Schammel
- University of South Carolina, School of Medicine, Greenville, South Carolina
| | | | - Avik Som
- Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts
| | - Husam El Khudari
- Department of Radiology, University of Alabama School of Medicine, Birmingham, Alabama
| | - A Michael Devane
- Department of Radiology, Clemson University School of Health Research, Clemson, South Carolina
| | - Andrew J Gunn
- Department of Radiology, University of Alabama School of Medicine, Birmingham, Alabama
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The changing trends of image-guided biopsy of small renal masses before intervention-an analysis of European multinational prospective EuRECA registry. Eur Radiol 2022; 32:4667-4678. [PMID: 35122492 PMCID: PMC8817647 DOI: 10.1007/s00330-022-08556-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Revised: 12/01/2021] [Accepted: 12/26/2021] [Indexed: 12/26/2022]
Abstract
Objectives To evaluate the use of pre-cryoablation biopsy for small renal masses (SRMs) and the effects of increasing uptake on histological results of treated SRMs. Methods From 2015 to 2019, patients with sporadic T1N0M0 SRMs undergoing percutaneous, laparoscopic, or open cryoablation from 14 European institutions within the European Registry for Renal Cryoablation (EuRECA) were included for the retrospective analysis. Univariate and multivariate logistic models were used to evaluate the trends, histological results, and the factors influencing use of pre-cryoablation biopsy. Results In total, 871 patients (median (IQR) age, 69 (14), 298 women) undergoing cryoablation were evaluated. The use of pre-cryoablation biopsy has significantly increased from 42% (65/156) in 2015 to 72% (88/122) in 2019 (p < 0.001). Patients treated for a benign histology are significantly more likely to have presented later in the trend, where pre-cryoablation biopsy is more prevalent (OR: 0.64, 95% CI 0.51–0.81, p < 0.001). Patients treated for undiagnosed histology are also significantly less likely to have presented in 2018 compared to 2016 (OR 0.31, 95% CI 0.10–0.97, p = 0.044). Patients aged 70+ are less likely to be biopsies pre-cryoablation (p < 0.05). R.E.N.A.L. nephrometry score of 10+ and a Charlson Comorbidity Index > 1 are factors associated with lower likelihood to not have received a pre-cryoablation biopsy (p < 0.05). Conclusion An increased use of pre-cryoablation biopsy was observed and cryoablation patients treated with a benign histology are more likely to have presented in periods where pre-cryoablation biopsy is not as prevalent. Comparative studies are needed to draw definitive conclusions on the effect of pre-cryoablation biopsy on SRM treatments. Key Points • The use of biopsy pre-ablation session has increased significantly from 42% of all patients in 2015 to 74% in 2019. • Patients are less likely to be treated for a benign tumour if they presented later in the trend, where pre-cryoablation biopsy is more prevalent, compared to later in the trend (OR 0.64, 95% CI 0.51–0.81, p < 0.001). • Patients with comorbidities or a complex tumour (R.E.N.A.L. nephrometry score > 10) are less likely to not undergo biopsy as a separate session to cryoablation. Supplementary Information The online version contains supplementary material available at 10.1007/s00330-022-08556-2.
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Papa M, Biondetti P, Colombo R, Ierardi AM, Angileri SA, Lucignani G, Boeri L, Montanari E, Cardone G, Scagnelli P, Carrafiello G. sABLATE: a simplified ABLATE score for prediction of complications and outcome in percutaneous thermal ablation of renal lesions. Med Oncol 2021; 38:126. [PMID: 34495438 DOI: 10.1007/s12032-021-01542-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Accepted: 05/23/2021] [Indexed: 11/28/2022]
Abstract
The aim of the study is to evaluate the performance of a simplified ABLATE score (sABLATE) in predicting complications and outcome with respect to RENAL, mRENAL, and ABLATE scores. This study included 136 renal lesions in 113 patients (M:F ratio = 2.5; mean age 70.8 years). 98 tumors underwent cryoablation at San Raffaele hospital between 01/2015 and 03/2020, while 37 underwent microwave ablation at San Paolo or Policlinico hospitals between 07/2016 and 03/2020. RENAL, mRENAL, ABLATE, and sABLATE scores were calculated using pre-procedural imaging. Data regarding complications and follow-up were registered. Mann-Whitney U test, ROC analyses, and logistic regression analyses were used for complications. Cox-regression analyses were performed for outcome. Mean tumor diameter was 23.2 mm. Mean and median RENAL, mRENAL, ABLATE, and sABLATE scores were 6.8 and 7, 6.9 and 7, 5.3, and 5, and 3.5 and 3, respectively. During a mean follow-up of 21.9 months (range 1-73), we registered 7 complications, 3 cases of residual disease, and 10 local tumor progressions. Mann-Whitney U test p values for complications for RENAL, mRENAL, ABLATE, and sABLATE were 0.51, 0.49, 0.66, and 0.056, respectively. ROC analyses for complications showed an AUC for RENAL, mRENAL, ABLATE, and sABLATE of 0.57, 0.57, 0.55, and 0.71, respectively. Regarding outcome, HR and p values of Cox-regression analyses were 1.30 and 0.36 for RENAL, 1.33 and 0.35 for mRENAL, 2.16 and 0.01 for ABLATE, 2.29 and 0.004 for sABLATE. sABLATE was the only score close to significance for complications, representing a progress even if not definitive. Regarding outcome, ABLATE confirmed its value, and sABLATE maintained validity despite being a simplification.
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Affiliation(s)
- Maurizio Papa
- Azienda Socio Sanitaria Territoriale (ASST) Lodi, Complex Unit of Radiology, Department of Diagnostic and Interventional Radiology, Viale Savoia 4, 26900, Lodi, Italy.
| | - Pierpaolo Biondetti
- Diagnostic and Interventional Radiology Department, IRCCS Cà Granda Fondazione Ospedale Maggiore Policlinico, Università degli studi di Milano, Milan, Italy
| | - Roberta Colombo
- Diagnostic and Interventional Radiology Department, IRCCS Cà Granda Fondazione Ospedale Maggiore Policlinico, Università degli studi di Milano, Milan, Italy
| | - Anna Maria Ierardi
- Diagnostic and Interventional Radiology Department, IRCCS Cà Granda Fondazione Ospedale Maggiore Policlinico, Università degli studi di Milano, Milan, Italy
| | - Salvatore Alessio Angileri
- Diagnostic and Interventional Radiology Department, IRCCS Cà Granda Fondazione Ospedale Maggiore Policlinico, Università degli studi di Milano, Milan, Italy
| | - Gianpaolo Lucignani
- Urology Department, IRCCS Cà Granda Fondazione Ospedale Maggiore Policlinico, Università degli studi di Milano, Milan, Italy
| | - Luca Boeri
- Urology Department, IRCCS Cà Granda Fondazione Ospedale Maggiore Policlinico, Università degli studi di Milano, Milan, Italy
| | - Emanuele Montanari
- Urology Department, IRCCS Cà Granda Fondazione Ospedale Maggiore Policlinico, Università degli studi di Milano, Milan, Italy
| | - Gianpiero Cardone
- Diagnostic and Interventional Radiology Department, IRCCS Ospedale San Raffaele-Turro, Università Vita-Salute San Raffaele, Milan, Italy
| | - Paola Scagnelli
- Azienda Socio Sanitaria Territoriale (ASST) Lodi, Complex Unit of Radiology, Department of Diagnostic and Interventional Radiology, Viale Savoia 4, 26900, Lodi, Italy
| | - Gianpaolo Carrafiello
- Diagnostic and Interventional Radiology Department, IRCCS Cà Granda Fondazione Ospedale Maggiore Policlinico, Università degli studi di Milano, Milan, Italy
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External Validation of the Renal Ablation-Specific (MC)2 Risk Scoring System in Predicting Complications from Percutaneous Renal Cryoablation. Cardiovasc Intervent Radiol 2021; 44:1763-1768. [PMID: 34327585 DOI: 10.1007/s00270-021-02929-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Accepted: 07/19/2021] [Indexed: 01/20/2023]
Abstract
PURPOSE The (MC)2 score is a renal ablation-specific risk scoring system to predict major complications from percutaneous renal cryoablation (PRCA). However, it is untested in an external population of patients. The purpose of this study is to validate the ability of the (MC)2 score to predict major complications after PRCA in an external population. MATERIALS AND METHODS Retrospective review of patients who underwent PRCA from 2004 to 2019. Patient demographics, medical histories, and tumor characteristics were collected. The (MC)2 score was calculated and patients were assigned to low risk (< 5), moderate risk (5-8) and high-risk (> 8) groups. Complications were recorded. Major complications were classified according to CIRSE guidelines. RESULTS Two hundred and one patients [M = 116; F = 85; median age = 65 (range 27-90)] met inclusion criteria. Eleven patients (5.5%) developed major complications and 50 patients (24.9%) developed minor complications. Of patients with major complications, mean tumor diameter was 39 mm (± 10.4), seven patients (63.6%) had a central tumor, four patients (36.4%) had complicated diabetes, and one patient (9.1%) had a prior MI. Major complication rates were 2.1%, 14%, and 14.3% in the (MC)2 low risk, moderate risk, and high risk groups, respectively. The mean (MC)2 score for patients with major complications [6.2 (± 2.4)] was higher than the mean score for patients with minor complications [4.7 (± 2.4) (p = 0.07)] and no complications [3.9 (± 1.9) (p < 0.01)]. The area under the ROC curve to predict major complications was 0.78. CONCLUSION The (MC)2 risk scoring system appropriately identifies patients at risk for major complications from PRCA in this external patient population.
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Campos TJFL, de V FE, Rocha MFH. Assessment of the complexity of renal tumors by nephrometry (R.E.N.A.L. score) with CT and MRI images versus 3D reconstruction model images. Int Braz J Urol 2021; 47:896-901. [PMID: 33848086 PMCID: PMC8321486 DOI: 10.1590/s1677-5538.ibju.2020.0930] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Accepted: 11/16/2020] [Indexed: 12/02/2022] Open
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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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Gunn AJ, Parikh NS, Bhatia S. Society of Interventional Radiology Quality Improvement Standards on Percutaneous Ablation in Renal Cell Carcinoma. J Vasc Interv Radiol 2020; 31:195-201.e3. [PMID: 31917026 DOI: 10.1016/j.jvir.2019.11.004] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Revised: 11/04/2019] [Accepted: 11/05/2019] [Indexed: 12/12/2022] Open
Affiliation(s)
- Andrew J Gunn
- Department of Radiology, University of Alabama at Birmingham, Birmingham, Alabama.
| | - Nainesh S Parikh
- Department of Diagnostic Imaging and Interventional Radiology, Moffitt Cancer Center, Tampa, Florida
| | - Shivank Bhatia
- Department of Interventional Radiology, University of Miami Miller School of Medicine, Miami, Florida
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Joe WB, Zarzour JG, Gunn AJ. Renal Cell Carcinoma Ablation: Preprocedural, Intraprocedural, and Postprocedural Imaging. Radiol Imaging Cancer 2019; 1:e190002. [PMID: 33778679 DOI: 10.1148/rycan.2019190002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Revised: 08/13/2019] [Accepted: 08/16/2019] [Indexed: 01/20/2023]
Abstract
The rising incidence of renal cell carcinoma (RCC) in recent decades necessitates careful consideration of additional treatment options, especially for patients who may be poor surgical candidates. An emerging body of evidence suggests that ablation may be performed effectively and safely even in patients with multiple comorbidities. Accordingly, clinical guidelines now include thermal ablation as an alternative for such patients with localized tumors that are 4.0 cm or smaller. Recent experience with these minimally invasive techniques has led to a greater understanding of the imaging findings that merit close attention when ablation is anticipated, or after it is performed. These imaging findings may guide the interventionalist's perception of the risks, technical challenges, and likelihood of treatment success associated with RCC ablation. The present review provides an overview of clinically relevant radiologic findings during the preprocedural, intraprocedural, and postprocedural period in the context of image-guided renal ablation. Keywords: Interventional-Body, Kidney, Percutaneous, Urinary © RSNA, 2019.
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Affiliation(s)
- Winston B Joe
- University of Alabama at Birmingham School of Medicine, Birmingham, Ala (W.B.J.); and Divisions of Abdominal Imaging (J.G.Z.) and Vascular and Interventional Radiology (A.J.G.), Department of Radiology, University of Alabama at Birmingham, 619 19th St S, Birmingham, AL 35249
| | - Jessica G Zarzour
- University of Alabama at Birmingham School of Medicine, Birmingham, Ala (W.B.J.); and Divisions of Abdominal Imaging (J.G.Z.) and Vascular and Interventional Radiology (A.J.G.), Department of Radiology, University of Alabama at Birmingham, 619 19th St S, Birmingham, AL 35249
| | - Andrew J Gunn
- University of Alabama at Birmingham School of Medicine, Birmingham, Ala (W.B.J.); and Divisions of Abdominal Imaging (J.G.Z.) and Vascular and Interventional Radiology (A.J.G.), Department of Radiology, University of Alabama at Birmingham, 619 19th St S, Birmingham, AL 35249
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Rembeyo G, Correas JM, Jantzen R, Audenet F, Dariane C, Delavaud C, Mejean A, Timsit MO. Percutaneous Ablation Versus Robotic Partial Nephrectomy in the Treatment of cT1b Renal Tumors: Oncologic and Functional Outcomes of a Propensity Score-weighted Analysis. Clin Genitourin Cancer 2019; 18:138-147. [PMID: 31982346 DOI: 10.1016/j.clgc.2019.10.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2019] [Revised: 09/25/2019] [Accepted: 10/06/2019] [Indexed: 01/20/2023]
Abstract
INTRODUCTION The purpose of this study was to assess oncologic and functional outcomes of both percutaneous ablation (cryoablation and radiofrequency ablation) and robot-assisted partial nephrectomy (RAPN) in the treatment of renal tumors larger than 4 cm. MATERIALS AND METHODS We retrospectively analyzed prospectively collected data from 102 consecutive patients, who underwent minimally invasive treatment for cT1b renal tumors at our institution. Primary renal function outcome was assessed by estimated glomerular filtration rate preservation at baseline and 1 year postoperatively. Perioperative data and functional and oncologic outcome were collected. Multivariate regression models were used to compare functional outcomes between groups. Cancer-specific survival and recurrence-free survival were estimated at 2 years using the Kaplan-Meier method and compared with Cox proportional hazards regression model to calculate hazard ratios (HRs). To control for selection bias between the different treatments, we adjusted our models with an inverse probability of treatment weighting propensity score. RESULTS There was no significant difference in renal preservation between the groups (P = .664). Multivariate analysis did not show a statistically significant difference in terms of renal function outcomes between the RAPN and percutaneous thermal ablation groups. The adjusted HR regarding the local recurrence-free survival was significantly shorter for the cryoablation group (HR, 4.3; 95% confidence interval, 1.78-10.37; P = .001). CONCLUSIONS Our study demonstrated the equivalence between RAPN and percutaneous ablative techniques for the preservation of renal function in the treatment of T1b tumors. RAPN offers a better local control than percutaneous ablation, in terms of primary success rate.
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Affiliation(s)
- Gregory Rembeyo
- Department of Urology, HEGP, Paris, France; Université Paris Descartes, Faculté de Médecine, Paris, France.
| | - Jean-Michel Correas
- Université Paris Descartes, Faculté de Médecine, Paris, France; Department of Adult Radiology, Hôpital NECKER - Enfant Malades, Paris, France
| | - Rodolphe Jantzen
- Université Paris Descartes, Faculté de Médecine, Paris, France; Medical Informatics, Biostatistics and Public Health Department, HEGP, Paris, France
| | - François Audenet
- Department of Urology, HEGP, Paris, France; Université Paris Descartes, Faculté de Médecine, Paris, France
| | - Charles Dariane
- Department of Urology, HEGP, Paris, France; Université Paris Descartes, Faculté de Médecine, Paris, France
| | - Christophe Delavaud
- Université Paris Descartes, Faculté de Médecine, Paris, France; Department of Adult Radiology, Hôpital NECKER - Enfant Malades, Paris, France
| | - Arnaud Mejean
- Department of Urology, HEGP, Paris, France; Université Paris Descartes, Faculté de Médecine, Paris, France
| | - Marc-Olivier Timsit
- Department of Urology, HEGP, Paris, France; Université Paris Descartes, Faculté de Médecine, Paris, France
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Aladağ Kurt S, Yücel C, Özhan Oktar S, Erbaş G, Sözen S, Öner AY. The effectiveness of RENAL nephrometry score in ablated renal tumors via radiofrequency ablation or cryoablation. Turk J Med Sci 2019; 49:761-768. [PMID: 31062941 PMCID: PMC7018310 DOI: 10.3906/sag-1811-131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Background/aim This study aimed to evaluate the clinical efficacy of radiofrequency ablation (RFA) and cryotherapy and to scrutinize the therapeutic success of the RENAL (radius, exophytic/endophytic, nearness to collecting system, anterior/posterior, and location) nephrometry score in terms of possible complications and the predictive status of oncological results. Materials and methods Forty-five patients with biopsy-proven renal cell carcinomas (32 males, 13 females) treated with RFA and cryotherapy were included. Patients were 22–90 years old (average: 59.2 years). Statistical analyses were performed using SPSS for Windows. Results A total of 79 lesions with dimensions varying between 0.9 and 4.5 cm (average: 2.2 cm) were ablated. Complete ablation was achieved for 72 (91.1%) lesions. Six repeat RFA sessions were applied for 4 (5%) lesions with residue/recurrence. The average RENAL nephrometry scores of lesions that underwent complete ablation and those that developed residue/recurrence were 6.3 and 7.7, respectively. The average recurrence-free survival time was 34.8 months (range: 3–55 months), while it was 44.6 months (range: 6–55 months) for cryotherapy and 28.6 months (range: 3–50 months) for RFA. Conclusion Ablative therapies are minimally invasive and effective methods for treating small renal tumors. RENAL nephrometry scoring is a valuable system for standardizing renal tumors and evaluating the success of ablative therapies, possible complications, and oncological results.
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Affiliation(s)
- Seda Aladağ Kurt
- Department of Radiology, Van Training and Research Hospital, Van, Turkey
| | - Cem Yücel
- Department of Radiology, Faculty of Medicine, Gazi University, Ankara, Turkey
| | - Suna Özhan Oktar
- Department of Radiology, Faculty of Medicine, Gazi University, Ankara, Turkey
| | - Gonca Erbaş
- Department of Radiology, Faculty of Medicine, Gazi University, Ankara, Turkey
| | - Sinan Sözen
- Department of Urology, Faculty of Medicine, Gazi University, Ankara, Turkey
| | - Ali Yusuf Öner
- Department of Radiology, Faculty of Medicine, Gazi University, Ankara, Turkey
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Gobara H, Nakatsuka A, Shimizu K, Yamanaka T, Matsui Y, Iguchi T, Hiraki T, Yamakado K. Cryoablation of renal cell carcinoma for patients with stage 4 or 5 non-dialysis chronic kidney disease. Jpn J Radiol 2019; 37:481-486. [DOI: 10.1007/s11604-019-00821-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Accepted: 02/11/2019] [Indexed: 01/18/2023]
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Rasner PI, Vasilyev AO, Govorov AV, Pushkar DY, Pushkarev AV, Shakurov AV, Tsiganov DI, Zherdev AA. [One-stage cryoablation of two renal tumors]. Khirurgiia (Mosk) 2019:95-100. [PMID: 30789616 DOI: 10.17116/hirurgia201901195] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The progressive development of medical technologies allowed the introduction of alternative methods of treatment of localized renal cell carcinoma with a tendency to organ-sparing approach. Cryoablation, radiofrequency ablation, and some experimental methods of treatment (microwave and laser ablation, therapy with high-intensity focused ultrasound) are referred to minimally invasive treatment of renal cell carcinoma. Cryoablation is highly effective alternative method of treatment of renal cell carcinoma. The main advantages of this technique are tumor visualization and formation of 'ice ball' in real time, fewer complications compared with other methods, as well as the possibility of cryotherapy in critically ill patients. Compared to other ablative technologies, cryoablation is followed by low percentage of redo treatment and good intermediate oncological results. We described the experience of one-stage cryoablation of two kidney tumors in this report.
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Affiliation(s)
- P I Rasner
- Department of Urology of the Evdokimov Moscow State University of Medicine and Dentistry, Moscow, Russia
| | - A O Vasilyev
- Department of Urology of the Evdokimov Moscow State University of Medicine and Dentistry, Moscow, Russia
| | - A V Govorov
- Department of Urology of the Evdokimov Moscow State University of Medicine and Dentistry, Moscow, Russia
| | - D Yu Pushkar
- Department of Urology of the Evdokimov Moscow State University of Medicine and Dentistry, Moscow, Russia
| | - A V Pushkarev
- Bauman Moscow State Technical University, Moscow, Russia
| | - A V Shakurov
- Bauman Moscow State Technical University, Moscow, Russia
| | - D I Tsiganov
- Bauman Moscow State Technical University, Moscow, Russia
| | - A A Zherdev
- Bauman Moscow State Technical University, Moscow, Russia
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Acosta Ruiz V, Ladjevardi S, Brekkan E, Häggman M, Lönnemark M, Wernroth L, Magnusson A. Periprocedural outcome after laparoscopic partial nephrectomy versus radiofrequency ablation for T1 renal tumors: a modified R.E.N.A.L nephrometry score adjusted comparison. Acta Radiol 2019; 60:260-268. [PMID: 29911400 DOI: 10.1177/0284185118780891] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND Comparable oncological outcomes have been seen after surgical nephrectomy and thermal ablation of renal tumors recently. However, periprocedural outcome needs to be assessed for aiding treatment decision. PURPOSE To compare efficacy rates and periprocedural outcome (technical success, session time, hospitalization time, and complications) after renal tumor treatment with laparoscopic partial nephrectomy (LPN) or radiofrequency ablation (RFA). MATERIAL AND METHODS The initial experience with 49 (treated with LPN) and 84 (treated with RFA) consecutive patients for a single renal tumor (diameter ≤ 5 cm, limited to the kidney) during 2007-2014 was evaluated. Patient and tumor characteristics, efficacy rates, and periprocedural outcome were collected retrospectively. The stratified Mantel Haenzel and Van Elteren tests, adjusted for tumor complexity (with the modified R.E.N.A.L nephrometry score [m-RNS]), were used to assess differences in treatment outcomes. RESULTS Primary efficacy rate was 98% for LPN and 85.7% for RFA; secondary efficacy rate was 93.9% for LPN and 95.2% for RFA; and technical success rate was 87.8% for LPN and 100% for RFA. Median session (m-RNS adjusted P < 0.001; LPN 215 min, RFA 137 min) and median hospitalization time were longer after LPN (m-RNS adjusted P < 0.001; LPN 5 days, RFA 2 days). Side effects were uncommon (LPN 2%, RFA 4.8%). Complications were more frequent after LPN (m-RNS adjusted P < 0.001; LPN 42.9%, RFA 10.7%). CONCLUSION Both methods achieved equivalent secondary efficacy rates. RFA included several treatment sessions, but session and hospitalization times were shorter, and complications were less frequent than for LPN. The differences remained after adjustment for renal tumor complexity.
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Affiliation(s)
- Vanessa Acosta Ruiz
- Department of Surgical Sciences – Radiology, Uppsala University, Uppsala, Sweden
| | - Sam Ladjevardi
- Department of Surgical Sciences – Urology, Uppsala University, Uppsala Sweden
| | - Einar Brekkan
- Uppsala University Hospital – Urology, Uppsala, Sweden
| | - Michael Häggman
- Department of Surgical Sciences – Urology, Uppsala University, Uppsala Sweden
| | - Maria Lönnemark
- Department of Surgical Sciences – Radiology, Uppsala University, Uppsala, Sweden
| | - Lisa Wernroth
- Department of Medical Sciences – Molecular Epidemiology, Uppsala University, Uppsala, Sweden
| | - Anders Magnusson
- Department of Surgical Sciences – Radiology, Uppsala University, Uppsala, Sweden
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22
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Renal cryoablation: Multidisciplinary, collaborative and perspective approach. Cryobiology 2018; 83:90-94. [DOI: 10.1016/j.cryobiol.2018.06.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2017] [Revised: 05/28/2018] [Accepted: 06/03/2018] [Indexed: 11/17/2022]
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Liu B, Zhan Y, Chen X, Xie Q, Wu B. Laparoscopic ultrasonography: The wave of the future in renal cell carcinoma? Endosc Ultrasound 2018; 7:161-167. [PMID: 29941724 PMCID: PMC6032702 DOI: 10.4103/eus.eus_27_18] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Laparoscopic or robotic surgery is the main method of treating renal cell carcinoma (RCC). Laparoscopic surgery can accurately target lesions and shorten patient recovery time. Renal endogenous tumors or inferior vena cava tumor thrombi are very difficult to remove using the laparoscopic approach. The emergence of laparoscopic ultrasonography (LUS) has solved this problem. LUS can assist in the detection of tumor boundaries and the extent of tumor thrombi. The lack of tactile feedback may hinder the development of laparoscopic surgery for the treatment of renal cancer. LUS has become an important tool that has improved the rates of successful surgery. LUS is applied in not only early and locally advanced RCC treatment but also in monitoring ablation therapy, testing renal blood perfusion, and exposing renal pedicles. Sonographic techniques used for LUS include initial B-mode, Doppler, and contrast-enhanced ultrasound (CEUS). Contrast agents applied for CEUS do not induce nephrotoxicity and can display renal perfusion more accurately than the regular color Doppler ultrasound. According to current literature, LUS is a promising technique for the treatment of RCC, especially for endogenous RCC or RCC with thrombosis, and for monitoring the effectiveness of radiofrequency ablation, although further well-designed studies are warranted.
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Affiliation(s)
- Bitian Liu
- Department of Urology, Shengjing Hospital of China Medical University, Shenyang, Liaoning Province, China
| | - Yunhong Zhan
- Department of Urology, Shengjing Hospital of China Medical University, Shenyang, Liaoning Province, China
| | - Xiaonan Chen
- Department of Urology, Shengjing Hospital of China Medical University, Shenyang, Liaoning Province, China
| | - Qingpeng Xie
- Department of Urology, Cancer Hospital of China Medial University, Liaoning Cancer Hospital, Shenyang, Liaoning Province, China
| | - Bin Wu
- Department of Urology, Shengjing Hospital of China Medical University, Shenyang, Liaoning Province, China
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[Ablative therapy in kidney cancer: Oncological, functional, perioperative outcomes and cost]. Prog Urol 2017; 27:952-970. [PMID: 28890005 DOI: 10.1016/j.purol.2017.08.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2017] [Accepted: 08/04/2017] [Indexed: 01/20/2023]
Abstract
INTRODUCTION The incidence of kidney cancer has increased significantly over the past few decades presumably due to the increased use of imaging. The aim of this article is to describe contemporary outcomes of ablative therapy and to compare them to other therapeutic options in terms of oncological, functional, perioperative outcomes and cost. MATERIAL AND METHODS We searched MEDLINE®, Embase®, using (MeSH) words; from January 2005 through May 2017, and we looked for all the studies. Investigators graded the strength of evidence in terms of methodology, language and relevance. RESULTS Ninety-one articles were analyzed. We described the outcomes of ablative therapy in relation to the energy used and the approach, and compared these outcomes to the other therapeutic options in terms of oncological, functional and perioperative outcomes. We analyzed these studies in order to search for predictive factors influencing the results of ablative therapy. We also analyzed the economic burden of small renal tumor management. CONCLUSION The strength of evidence is based almost entirely on retrospective studies and is susceptible to the inherent limitations of this study design. Although, the evidence was low among studies, our revue showed that, in elderly patients treated with ablative therapy for cT1a tumors, the cancer-specific survival was comparable to partial nephrectomy with differences in overall survival that are explained by competing risks of death in the old population. Considering the functional results, the renal function preservation seems to be comparable between the 2 groups while the perioperative morbidity is higher in the partial nephrectomy group. The evidence base medicine at this time cannot support the extension of the indications of ablative therapy beyond the actual implementations.
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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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26
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Chan P, Vélasco S, Vesselle G, Boucebci S, Herpe G, Debaene B, Ingrand P, Irani J, Tasu JP. Percutaneous microwave ablation of renal cancers under CT guidance: safety and efficacy with a 2-year follow-up. Clin Radiol 2017; 72:786-792. [PMID: 28545682 DOI: 10.1016/j.crad.2017.03.029] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2016] [Revised: 02/21/2017] [Accepted: 03/13/2017] [Indexed: 01/20/2023]
Abstract
AIM To evaluate the safety and efficiency of percutaneous microwave ablation (MWA) of renal cell carcinomas (RCC) carried out under computed tomography (CT) guidance. MATERIALS AND METHODS A retrospective study was performed on RCC that was either histologically proven or diagnosed at imaging (Bosniak IV cyst) and treated by MWA under general anaesthesia with CT guidance. Indications for percutaneous ablation were based on the American Urological Association recommendations. Twenty-four months post-procedure follow-up was performed. RESULTS Sixty-two patients presenting one or more RCC (84 tumours ranging from 10-48 mm in diameter; mean diameter: 25.6 mm) were included. Technical success was achieved for 78 tumours (58 patients). For four patients, the treatment was stopped due to gas dissection failure. At 3 months, six residual tumours were observed (8%). At 6 months, two recurrences and one residual tumour (3.8%) were observed; all were retreated with complete success. At 12 months, local control of the disease was achieved in 94% of cases (100% in cases where treatment was performed). Two cases of distal metastasis were observed after 12 and 24 months. At 24 months, one patient presented with a contralateral tumour. The complication rate was 4.8% including one grade III complication and two grade II complications according to the Clavien-Dindo classification. At 2 years, the cumulative disease-free survival rate and overall survival were 95% and 97%, respectively. CONCLUSION MWA ablation under CT guidance to treat RCC is safe and provides a high rate of effectiveness at 24 months.
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Affiliation(s)
- P Chan
- Imaging Department, CHU de Poitiers, 2 rue de la milétrie, 86000 CHU de Poitiers, France
| | - S Vélasco
- Imaging Department, CHU de Poitiers, 2 rue de la milétrie, 86000 CHU de Poitiers, France
| | - G Vesselle
- Imaging Department, CHU de Poitiers, 2 rue de la milétrie, 86000 CHU de Poitiers, France
| | - S Boucebci
- Imaging Department, CHU de Poitiers, 2 rue de la milétrie, 86000 CHU de Poitiers, France
| | - G Herpe
- Imaging Department, CHU de Poitiers, 2 rue de la milétrie, 86000 CHU de Poitiers, France
| | - B Debaene
- Anesthesiology Department, CHU de Poitiers, 2 rue de la milétrie, 86000 CHU de Poitiers, France
| | - P Ingrand
- Inserm U619, CHU de Poitiers et University of Poitiers, rue de la milétrie, 86000 CHU de Poitiers, France
| | - J Irani
- Inserm U619, CHU de Poitiers et University of Poitiers, rue de la milétrie, 86000 CHU de Poitiers, France; Urology Department, CHU de Poitiers, 2 rue de la milétrie, 86000 CHU de Poitiers, France
| | - J-P Tasu
- Imaging Department, CHU de Poitiers, 2 rue de la milétrie, 86000 CHU de Poitiers, France.
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Maxwell AWP, Baird GL, Iannuccilli JD, Mayo-Smith WW, Dupuy DE. Renal Cell Carcinoma: Comparison of RENAL Nephrometry and PADUA Scores with Maximum Tumor Diameter for Prediction of Local Recurrence after Thermal Ablation. Radiology 2017; 283:590-597. [DOI: 10.1148/radiol.2016161225] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Affiliation(s)
- Aaron W. P. Maxwell
- From the Department of Diagnostic Imaging, The Warren Alpert Medical School of Brown University, 593 Eddy St, Providence, RI 02903 (A.W.P.M., G.L.B., J.D.I., D.E.D.); and Department of Radiology, Brigham and Women’s Hospital, Boston, Mass (W.W.M.S.)
| | - Grayson L. Baird
- From the Department of Diagnostic Imaging, The Warren Alpert Medical School of Brown University, 593 Eddy St, Providence, RI 02903 (A.W.P.M., G.L.B., J.D.I., D.E.D.); and Department of Radiology, Brigham and Women’s Hospital, Boston, Mass (W.W.M.S.)
| | - Jason D. Iannuccilli
- From the Department of Diagnostic Imaging, The Warren Alpert Medical School of Brown University, 593 Eddy St, Providence, RI 02903 (A.W.P.M., G.L.B., J.D.I., D.E.D.); and Department of Radiology, Brigham and Women’s Hospital, Boston, Mass (W.W.M.S.)
| | - William W. Mayo-Smith
- From the Department of Diagnostic Imaging, The Warren Alpert Medical School of Brown University, 593 Eddy St, Providence, RI 02903 (A.W.P.M., G.L.B., J.D.I., D.E.D.); and Department of Radiology, Brigham and Women’s Hospital, Boston, Mass (W.W.M.S.)
| | - Damian E. Dupuy
- From the Department of Diagnostic Imaging, The Warren Alpert Medical School of Brown University, 593 Eddy St, Providence, RI 02903 (A.W.P.M., G.L.B., J.D.I., D.E.D.); and Department of Radiology, Brigham and Women’s Hospital, Boston, Mass (W.W.M.S.)
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Microwave ablation of malignant renal tumours: intermediate-term results and usefulness of RENAL and mRENAL scores for predicting outcomes and complications. Med Oncol 2017; 34:97. [PMID: 28421553 DOI: 10.1007/s12032-017-0948-8] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2016] [Accepted: 04/04/2017] [Indexed: 01/20/2023]
Abstract
The aim of this study was to evaluate intermediate-term results after microwave ablation (MWA) of renal tumours and determine the association of RENAL and modified RENAL (mRENAL) scores with oncological outcomes and complications. In May 2008-September 2014, 58 patients affected by early-stage RCC (renal cell carcinoma; T1a or T1b) were judged unsuitable for surgery and treated with percutaneous MWA. Follow-up was performed with contrast-enhanced computed tomography at 1, 3, 6, 12 and 24 months after the procedure. Technical success (TS), primary technical effectiveness (PTE), secondary technical effectiveness (STE), the local tumour progression rate (LTPR), the cancer-specific survival rate (CSSR), disease-free survival (DFS), overall survival (OS) and safety were recorded. All lesions were evaluated using RENAL and mRENAL scores, and complications were assessed with RENAL scores. The TS rate was 100%, PTE was 93%, STE was 100%, LTPR was 15.7% at 1 year, CSSR was 96.5%, DFS was 87.9% at 5 years, and OS was 80.6%. Mean follow-up was 25.7 months (range 3-72). The mean ± standard deviation (SD) RENAL and mRENAL scores of all treated tumours were 6.7 ± 2.05 (range 4-11) and 7 ± 2.3 (range 4-12), respectively. Major complications occurred in two (2/58) and minor complications in three patients (3/58). Overall complications correlated significantly with RENAL scores; in particular, E and L represent negative predictors for safety and effectiveness. MWA is a valuable alternative for treating RCCs. The correlation with outcomes and complications of RENAL and mRENAL scores could help to customise MWA indications in RCC patients.
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Bhindi B, Thompson RH, Mason RJ, Haddad MM, Geske JR, Kurup AN, Hannon JD, Boorjian SA, Leibovich BC, Atwell TD, Schmit GD. Comprehensive assessment of renal tumour complexity in a large percutaneous cryoablation cohort. BJU Int 2017; 119:905-912. [DOI: 10.1111/bju.13841] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Affiliation(s)
- Bimal Bhindi
- Department of Urology; Mayo Clinic; Rochester MN USA
| | | | - Ross J. Mason
- Department of Urology; Mayo Clinic; Rochester MN USA
| | | | - Jennifer R. Geske
- Division of Biomedical Statistics and Informatics; Mayo Clinic; Rochester MN USA
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30
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Joshi SS, Uzzo RG. Renal Tumor Anatomic Complexity: Clinical Implications for Urologists. Urol Clin North Am 2017; 44:179-187. [PMID: 28411910 DOI: 10.1016/j.ucl.2016.12.004] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Anatomic tumor complexity can be objectively measured and reported using nephrometry. Various scoring systems have been developed in an attempt to correlate tumor complexity with intraoperative and postoperative outcomes. Nephrometry may also predict tumor biology in a noninvasive, reproducible manner. Other scoring systems can help predict surgical complexity and the likelihood of complications, independent of tumor characteristics. The accumulated data in this new field provide provocative evidence that objectifying anatomic complexity can consolidate reporting mechanisms and improve metrics of comparisons. Further prospective validation is needed to understand the full descriptive and predictive ability of the various nephrometry scores.
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Affiliation(s)
- Shreyas S Joshi
- Division of Urologic Oncology, Department of Surgical Oncology, Fox Chase Cancer Center, Temple University Health System, 333 Cottman Avenue, Philadelphia, PA 19111, USA.
| | - Robert G Uzzo
- Division of Urologic Oncology, Department of Surgical Oncology, Fox Chase Cancer Center, Temple University Health System, 333 Cottman Avenue, Philadelphia, PA 19111, USA
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Abstract
The management of small renal masses has become an important public health topic. The increased use of cross-sectional imaging and ultrasound has led to a downward stage migration for the detection of small renal masses. Cancer-specific survival, however, has not reflected this trend accordingly. Although partial nephrectomy has been the mainstay of treatment of small renal masses less than 4 cm, there is growing interest in ablative therapies, such as cryoablation and radiofrequency ablation, due to decreased morbidity. Oncologic outcomes are limited by methodology and length of follow-up, but short-term recurrence rates are low.
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Non-Surgical Ablative Therapy for Management of Small Renal Masses-Current Status and Future Trends. Indian J Surg Oncol 2017; 8:39-45. [PMID: 28127181 DOI: 10.1007/s13193-016-0598-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2016] [Accepted: 09/16/2016] [Indexed: 10/20/2022] Open
Abstract
A large number of small renal masses (SRMs) with size less than 4 cm are being identified due to advances in diagnostic imaging. As the natural history of these tumours remains unknown, there is no reliable way to predict their behaviour or future growth. Although, partial nephrectomy is the gold standard for treatment of these tumours, ablative non-surgical therapies such as cryoablation and radiofrequency ablation provide a less invasive option of treatment with comparable oncological outcomes. In this systematic review, the principle, indications, methods of treatment, oncological control, complication and renal function of ablative therapies are critically reviewed. Cryotherapy utilizes the principle of inducing tissue destruction by freezing and thawing using argon and helium gasses, respectively. Radiofrequency ablation (RFA) works on the principle of tissue heating. Ablative treatments are particularly useful in the elderly patients, those with comorbidities or in patients with SRMs in solitary kidneys or renal impairment. Ablative therapies have less procedure-related complications and have promising medium-term oncological outcome. Longer-term results are accumulating. Cryotherapy may be a better modality for oncological control than RFA. Ablative therapy has emerged as a viable treatment options for SRMs with recurrence free survival rates approaching that of extirpative surgery. However, there is no consensus in the literature on the best selection criteria and this needs further refinement. Prospective long-term data with regards to oncological control is still needed.
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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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Gao Y, Liang P, Yu X, Yu J, Cheng Z, Han Z, Duan S, Huang H. Microwave treatment of renal cell carcinoma adjacent to renal sinus. Eur J Radiol 2016; 85:2083-2089. [DOI: 10.1016/j.ejrad.2016.09.018] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2016] [Revised: 08/26/2016] [Accepted: 09/19/2016] [Indexed: 11/16/2022]
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Nielsen TK, Lagerveld BW, Keeley F, Lughezzani G, Sriprasad S, Barber NJ, Hansen LU, Buffi NM, Guazzoni G, van der Zee JA, Ismail M, Farrag K, Emara AM, Lund L, Østraat Ø, Borre M. Oncological outcomes and complication rates after laparoscopic-assisted cryoablation: a European Registry for Renal Cryoablation (EuRECA) multi-institutional study. BJU Int 2016; 119:390-395. [PMID: 27488479 DOI: 10.1111/bju.13615] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
OBJECTIVE To assess complication rates and intermediate oncological outcomes of laparoscopic-assisted cryoablation (LCA) in patients with small renal masses (SRMs). PATIENTS AND METHODS A retrospective review of 808 patients treated with LCA for T1a SRMs from 2005 to 2015 at eight European institutions. Complications were analysed according to the Clavien-Dindo classification. Kaplan-Meier analyses were used to estimate 5- and 10-year disease-free survival (DFS) and overall survival (OS). RESULTS The median [interquartile (IQR)] age was 67 (58-74) years. The median (IQR) tumour size was 25 (19-30) mm. The transperitoneal approach was used in 77.7% of the patients. The median postoperative hospital stay was 2 days. In all, 514 patients with a biopsy-confirmed renal cell carcinoma (RCC) were available for survival analyses. The median (IQR) follow-up for the RCC-cohort was 36 (14-56) months. A total of 32 patients (6.2%) were diagnosed with treatment failure. The 5-/10-year DFS was 90.4%/80.0% and 5-/10-year OS was 83.2%/64.4%, respectively. A total of 134 postoperative complications (16.6%) were reported, with severe complications (grade ≥III) in 26 patients (3.2%). An American Society of Anesthesiologists score of 3 was associated with an increased risk of overall complications (odds ratio 2.85, 95% confidence interval 1.32-6.20; P = 0.005). CONCLUSIONS This large series of LCA demonstrates satisfactory long-term oncological outcomes for SRMs. However, although LCA is considered a minimally invasive procedure, risk of complications should be considered when counselling patients.
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Affiliation(s)
- Tommy K Nielsen
- Department of Urology, Aarhus University Hospital, Aarhus, Denmark
| | - Brunolf W Lagerveld
- Department of Urology, Onze Lieve Vrouwe Gasthuis, Amsterdam, the Netherlands
| | | | - Giovanni Lughezzani
- Department of Urology, Istituto Clinico Humanitas IRCCS, Clinical and Research Hospital, Milano, Rozzano, Italy
| | | | - Neil J Barber
- Department of Urology, Frimley Park Hospital, Camberley, UK
| | - Lars U Hansen
- Department of Urology, Aarhus University Hospital, Aarhus, Denmark.,Department of Urology, Odense University Hospital, Odense, Denmark
| | - Nicole M Buffi
- Department of Urology, Istituto Clinico Humanitas IRCCS, Clinical and Research Hospital, Milano, Rozzano, Italy
| | - Giorgio Guazzoni
- Department of Urology, Istituto Clinico Humanitas IRCCS, Clinical and Research Hospital, Milano, Rozzano, Italy
| | - Johan A van der Zee
- Department of Urology, Onze Lieve Vrouwe Gasthuis, Amsterdam, the Netherlands
| | | | - Khaled Farrag
- Department of Urology, Darent Vally Hospital, Dartford, UK
| | - Amr M Emara
- Department of Urology, Frimley Park Hospital, Camberley, UK.,Department of Urology, Ain Shams University, Cairo, Egypt
| | - Lars Lund
- Department of Urology, Odense University Hospital, Odense, Denmark.,Department of Urology, Viborg Regional Hospital, Viborg, Denmark
| | - Øyvind Østraat
- Department of Urology, Aarhus University Hospital, Aarhus, Denmark
| | - Michael Borre
- Department of Urology, Aarhus University Hospital, Aarhus, Denmark
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Kakarala B, Frangakis CE, Rodriguez R, Georgiades CS. Hemorrhagic Complications of Percutaneous Cryoablation for Renal Tumors: Results from a 7-year Prospective Study. Cardiovasc Intervent Radiol 2016; 39:1604-1610. [PMID: 27435583 DOI: 10.1007/s00270-016-1419-x] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2016] [Accepted: 07/07/2016] [Indexed: 11/29/2022]
Abstract
PURPOSE Cryoablation of renal tumors is assumed to have a higher risk of hemorrhagic complications compared to other ablative modalities. Our purpose was to establish the exact risk and to identify hemorrhagic risk factors. MATERIALS AND METHODS This IRB approved, 7-year prospective study included 261 renal cryoablations. Procedures were under conscious sedation and CT guidance. Pre- and postablation CT was obtained, and hemorrhagic complications were CTCAE tabulated. Age, gender, tumor size, histology, and probes number were tested based on averages or proportions using their exact permutation distribution. "High-risk" subgroups (those exceeding the thresholds of all variables) were tested for each variable alone, and for all combinations of variable threshold values. We compared the subgroup with the best PPV using one variable, with the subgroup with the best PPV using all variables (McNemmar test). RESULTS The hemorrhagic complication rate was 3.5 %. Four patients required transfusions, two required emergent angiograms, one required both a transfusion and angiogram, and two required bladder irrigation for outlet obstruction. Perirenal space hemorrhage was more clinically significant than elsewhere. Univariate risks were tumor size >2 cm, number of probes >2, and malignant histology (P = 0.005, 0.002, and 0.033, respectively). Multivariate analysis showed that patients >55 years with malignant tumors >2 cm requiring 2 or more probes yielded the highest PPV (7.5 %). CONCLUSIONS Although older patients (>55 years old) with larger (>2 cm), malignant tumors have an increased risk of hemorrhagic complications, the low PPV does not support the routine use of embolization. Percutaneous cryoablation has a 3.5 % risk of significant hemorrhage, similar to that reported for other types of renal ablative modalities.
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Affiliation(s)
- Bharat Kakarala
- Vascular and Interventional Radiology, Johns Hopkins University, Baltimore, MD, USA.
| | - Constantine E Frangakis
- Biostatistics and Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Ron Rodriguez
- Urologic Surgery, University of Texas Health Science Center, San Antonio, TX, USA
| | - Christos S Georgiades
- Johns Hopkins University, 1800 Orleans Street-Sheikh Zayed Tower-Suite 7203, Baltimore, MD, USA
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Quiroga Matamoros W, Fernandez F, Citarella Otero D, Rangel J, Estrada Guerrero A, Patiño ID. Guía de manejo del carcinoma de células renales. Rev Urol 2016. [DOI: 10.1016/j.uroco.2016.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Nielsen TK, Lagerveld BW, Østraat Ø, Andersen G, Høyer S, van der Zee J, Nonboe L, Graumann O, Borre M. Preoperative Aspects and Dimensions Used for Anatomical Score Predicts Treatment Failures in Laparoscopic Cryoablation of Small Renal Masses. J Endourol 2016; 30:537-43. [DOI: 10.1089/end.2015.0824] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Affiliation(s)
| | | | - Øyvind Østraat
- Department of Urology, Aarhus University Hospital, Aarhus, Denmark
| | - Gratien Andersen
- Department of Radiology, Aarhus University Hospital, Aarhus, Denmark
| | - Søren Høyer
- Department of Pathology, Aarhus University Hospital, Aarhus, Denmark
| | - Johan van der Zee
- Department of Urology, Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands
| | - Lasse Nonboe
- Department of Urology, Aarhus University Hospital, Aarhus, Denmark
| | - Ole Graumann
- Department of Radiology, Aarhus University Hospital, Aarhus, Denmark
| | - Michael Borre
- Department of Urology, Aarhus University Hospital, Aarhus, Denmark
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Zargar H, Atwell TD, Cadeddu JA, de la Rosette JJ, Janetschek G, Kaouk JH, Matin SF, Polascik TJ, Zargar-Shoshtari K, Thompson RH. Cryoablation for Small Renal Masses: Selection Criteria, Complications, and Functional and Oncologic Results. Eur Urol 2016; 69:116-28. [DOI: 10.1016/j.eururo.2015.03.027] [Citation(s) in RCA: 78] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2015] [Accepted: 03/11/2015] [Indexed: 12/27/2022]
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Rodriguez Faba O, Akdogan B, Marszalek M, Langenhuijsen JF, Brookman-May S, Stewart GD, Capitanio U, Sanguedolce F. Current Status of Focal Cryoablation for Small Renal Masses. Urology 2015; 90:9-15. [PMID: 26743392 DOI: 10.1016/j.urology.2015.11.041] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2015] [Revised: 11/21/2015] [Accepted: 11/30/2015] [Indexed: 12/27/2022]
Abstract
Focal cryoablation is an established minimally invasive technique for the treatment of small renal masses. Because of the lack of robust evidence, it is indicated in selected patients who have relative contraindications to extirpative approaches. With appropriate selection of patients, cryoablation is safe and effective. Main advantages are low risk for complication, minimal invasiveness, and good functional outcomes; oncological outcomes require further studies. The role of the percutaneous approach has been expanding because of its ability to reduce pain and hospitalization, the possibility of performing the procedure under sedation, and the fact that it is potentially more cost effective.
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Affiliation(s)
| | - Bullent Akdogan
- Department of Urology, Hacettepe University, School of Medicine, Ankara, Turkey
| | | | - J F Langenhuijsen
- Department of Urology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Sabine Brookman-May
- Department of Urology, Ludwig Maximilian University, Campus Grosshadern, Munich, Germany
| | - Grant D Stewart
- Edinburgh Urological Cancer Group, Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh, UK
| | - Umberto Capitanio
- King's College Hospital NHS Foundation Trust, Northampton General Hospital NHS Trust, Cliftonville, UK
| | - Francesco Sanguedolce
- Department of Urology, Vita-Salute San Raffaele University, IRCCS San Raffaele Scientific Institute, Milan, Italy
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Rodriguez Faba O, Sanguedolce F, Grange P, Kooiman G, Bakavicius A, De la Torre P, Palou J. Kidney cancer focal cryoablation trend: does location or approach matter? World J Urol 2015; 34:917-23. [PMID: 26498138 DOI: 10.1007/s00345-015-1716-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2015] [Accepted: 10/16/2015] [Indexed: 01/16/2023] Open
Abstract
PURPOSE We evaluated the current indications and surgical and survival outcomes for cryoablation (CA) using either a percutaneous (PCA) or a laparoscopic approach (LCA). We also investigated the ability of the PADUA score to predict the risk of complications and local recurrence. METHODS A retrospective analysis was performed at two European tertiary referral centers. Parameters analyzed included size, location, approach, operative time, hospital stay, complications, and functional and oncologic outcomes. Univariate and multivariate analyses were performed. An ROC analysis was conducted to evaluate the accuracy of the PADUA score. RESULTS Eighty patients were included. Mean tumor size was 2.6 cm. PCA was more often performed in posterior (95 vs. 60 %), inferior (72 vs. 32 %), and lateral (87 vs. 55 %) tumors. The global complication rate was 8.75 %, although proximity to the renal sinus resulted in a higher rate (30 vs. 4 %). Mean follow-up was 34 and 23 months for LCA and PCA, respectively. The 5-year recurrence-free survival was 76 and 90 % for LCA and PCA, respectively. Multivariate analysis showed that tumor involvement of the collecting system was predictive of recurrence. Under ROC analysis, PADUA score was a mild predictor for complications (AUC = 0.601) and a good predictor for recurrence (AUC = 0.723); PADUA ≥8 was identified as a cutoff for patients to a higher risk of recurrence. CONCLUSIONS The percutaneous approach is confirmed to be the preferred CA technique for posterior and lateral tumors. CA in deeper renal lesions and tumors with PADUA score ≥8 might entail a higher risk of recurrence, and closer follow-up should be considered in these patients.
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Affiliation(s)
- O Rodriguez Faba
- Department of Urology and Radiology, Fundació Puigvert, Barcelona, Spain.
| | | | - P Grange
- King's College Hospital, London, UK
| | | | - A Bakavicius
- Department of Urology, Vilnius University Hospital Santariskiu Klinikos, Vilnius, Lithuania
| | - P De la Torre
- Department of Urology and Radiology, Fundació Puigvert, Barcelona, Spain
| | - J Palou
- Department of Urology and Radiology, Fundació Puigvert, Barcelona, Spain
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Les traitements ablatifs dans le cancer du rein localisé : revue de la littérature en 2014. Prog Urol 2015; 25:499-509. [DOI: 10.1016/j.purol.2015.04.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2014] [Revised: 04/27/2015] [Accepted: 04/29/2015] [Indexed: 01/25/2023]
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Laparoscopic vs Percutaneous Cryoablation for the Small Renal Mass: 15-Year Experience at a Single Center. Urology 2015; 85:850-5. [DOI: 10.1016/j.urology.2015.01.004] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2014] [Revised: 12/13/2014] [Accepted: 01/05/2015] [Indexed: 11/21/2022]
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Chang X, Liu T, Zhang F, Qian C, Ji C, Zhao X, Liu G, Guo H. The Comparison of R.E.N.A.L., PADUA and Centrality Index Score in Predicting Perioperative Outcomes and Complications after Laparoscopic Radio Frequency Ablation of Renal Tumors. J Urol 2015; 194:897-902. [PMID: 25813450 DOI: 10.1016/j.juro.2015.03.095] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/18/2015] [Indexed: 01/20/2023]
Abstract
PURPOSE We assessed the association between the R.E.N.A.L., PADUA and centrality index scores and perioperative outcomes, and determined the efficacy of each scoring system over the simple parameter of tumor size. MATERIALS AND METHODS We conducted a retrospective review of the records of patients who underwent laparoscopic radio frequency ablation of renal tumors from February 2006 to April 2014 at our institution. Tumors were categorized using the R.E.N.A.L., PADUA and centrality index score, which were determined by analyzing preoperative imaging. The relationships between each variable and change in glomerular filtration rate, estimated blood loss, operative time and postoperative complications were examined. RESULTS Laparoscopic radio frequency ablation was performed in 215 selected patients with preoperative imaging available. The interclass correlations coefficient of the 3 observers was 0.87, 0.84 and 0.82 for the C-Index, the R.E.N.A.L. and the PADUA scoring system, respectively. R.E.N.A.L. score, PADUA score and PADUA complexity were significantly associated with postoperative complications (p=0.040, 0.015 and 0.006, respectively). However, major complications were only associated with high PADUA complexity (chi-square 23.851, p <0.05). Each scoring system had a significant association with operative time and estimated blood loss (p <0.05), except that the C-index score had no relationship with estimated blood loss (p=0.083). The accuracy of each scoring system in predicting perioperative outcomes and postoperative complications was superior to that of tumor size. CONCLUSIONS Each scoring system has an advantage over tumor size in describing tumor complexity and may help with surgical decision making. Further studies are required to validate their efficacy in evaluating the intraoperative and postoperative results after renal laparoscopic radio frequency ablation.
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Affiliation(s)
- Xiaofeng Chang
- Department of Urology, the Affiliated Nanjing Drum Tower Hospital, Medical School of Nanjing University, Nanjing, China; Jiangsu Key Laboratory of Molecular and Functional Imaging, Department of Radiology, Zhongda Hospital, Medical School, Southeast University, Nanjing, China
| | - Tieshi Liu
- Department of Urology, the Affiliated Nanjing Drum Tower Hospital, Medical School of Nanjing University, Nanjing, China
| | - Fan Zhang
- Department of Urology, the Affiliated Nanjing Drum Tower Hospital, Medical School of Nanjing University, Nanjing, China
| | - Cheng Qian
- Jiangsu Key Laboratory of Molecular and Functional Imaging, Department of Radiology, Zhongda Hospital, Medical School, Southeast University, Nanjing, China
| | - Changwei Ji
- Department of Urology, the Affiliated Nanjing Drum Tower Hospital, Medical School of Nanjing University, Nanjing, China
| | - Xiaozhi Zhao
- Department of Urology, the Affiliated Nanjing Drum Tower Hospital, Medical School of Nanjing University, Nanjing, China
| | - Guangxiang Liu
- Department of Urology, the Affiliated Nanjing Drum Tower Hospital, Medical School of Nanjing University, Nanjing, China
| | - Hongqian Guo
- Department of Urology, the Affiliated Nanjing Drum Tower Hospital, Medical School of Nanjing University, Nanjing, China.
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Nisen H, Heimonen P, Kenttä L, Visapää H, Nisen J, Taari K. Renal tumour anatomical characteristics and functional outcome after partial nephrectomy. Scand J Urol 2014; 49:193-9. [DOI: 10.3109/21681805.2014.978819] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
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Benadiba S, Verin AL, Pignot G, Bessede T, Drai J, Bahi R, Toussile W, Rocher L, Patard JJ. Are urologists and radiologists equally effective in determining the RENAL Nephrometry score? Ann Surg Oncol 2014; 22:1618-24. [PMID: 25384701 DOI: 10.1245/s10434-014-4152-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2014] [Indexed: 12/23/2022]
Abstract
BACKGROUND The RENAL nephrometry score (RNS) allows description of the anatomy and the complexity of renal masses. This study aimed to investigate the interobserver reproducibility of the RNS between a radiologist and a urologist. METHODS The computed tomography (CT) scans of patients undergoing partial nephrectomy in the authors' department between June 2010 and June 2013 were analyzed for determination of the RNS by a urologist and a radiologist blinded to the medical records. Cohen's kappa coefficient was used for interobserver reproducibility assessment. Correlations with per- and postoperative complication rates and renal function were assessed. RESULTS The study included 52 consecutive patients with a mean age of 55 years. The average score was 7.4 ± 1.7 for the urologist and 7.3 ± 1.5 for the radiologist. The Cohen's kappa was 0.81 for R, 0.47 for E, 0.63 for N, 0.28 for A, and 0.21 for L. The Pearson's coefficient for the total RNS was 0.70. The operative time and the occurrence of major complications were significantly correlated with the complexity assessed by the score of both observers. In the univariate analysis, the RNS, the American Society of Anesthesiologists score, and the patient's age were significantly associated with major complication rates. In the multivariate analysis, the RNS remained significantly associated with major complications. No significant difference in postoperative renal function according to complexity group was found by either the urologist or the radiologist. CONCLUSIONS The reproducibility of the RNS between the radiologist and the urologist was not very good, especially for some items referring to the location of the tumor, although the major complication rates were significantly associated with the RNS for both observers.
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Affiliation(s)
- Steeve Benadiba
- Urology Department, Bicetre Hospital, University Paris XI, Le Kremlin Bicêtre, France
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Krummel T, Garnon J, Lang H, Gangi A, Hannedouche T. Percutaneous cryoablation for tuberous sclerosis-associated renal angiomyolipoma with neoadjuvant mTOR inhibition. BMC Urol 2014; 14:77. [PMID: 25258166 PMCID: PMC4177726 DOI: 10.1186/1471-2490-14-77] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2014] [Accepted: 09/22/2014] [Indexed: 12/21/2022] Open
Abstract
Background Renal angiomyolipomas (AMLs) are frequent in tuberous sclerosis and are responsible for a significant proportion of the morbidity in adulthood, mainly from bleeding complications, which are correlated to the size of the AMLs. We describe the case of a 19-year-old female with multiple bilateral renal angiomyolipomas. Case presentation The renal AMLs measured up to 6 cm in size. She was first treated with a low dose of the mammalian target of rapamycin (mTOR) inhibitor sirolimus (up to 3 mg/day over a 12-month period) and following significant AML size reduction, percutaneous cryoablation was performed. No side-effects of either treatment were reported. At 12 months post-cryoablation, no recurrence of the AML was noted. Conclusion This is the first report of this treatment strategy and the case study reveals that combining a low dose of an mTOR inhibitor with percutaneous cryoablation to treat small tumors mitigates the side-effects while providing a good clinical outcome. This therapeutic approach is a novel tool for the clinician involved in the management of patients with tuberous sclerosis.
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Affiliation(s)
- Thierry Krummel
- Department of Nephrology, University Hospital, Strasbourg, France.
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Millman AL, Pace KT, Ordon M, Lee JY. Surgeon-specific factors affecting treatment decisions among Canadian urologists in the management of pT1a renal tumours. Can Urol Assoc J 2014; 8:183-9. [PMID: 25024788 DOI: 10.5489/cuaj.1884] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
INTRODUCTION The ubiquitous use of diagnostic imaging has resulted in an increased incidental detection of small renal masses (SRM). Patient- and tumour-related factors affect treatment decisions greatly; however, with multiple treatment options available, surgeon-specific characteristics and biases may also influence treatment recommendations. We determine the impact of surgeon-specific factors on treatment decisions in the management of SRM in Canada. METHODS An online survey study was conducted among Canadian urologists currently registered with the Canadian Urological Association. The questionnaire collected demographic information and recommended treatments for 6 SRM index cases involving theoretical patients of various ages (51-80 years) and comorbidities. RESULTS A total of 110 urologists responded (17% response rate) to the survey. Of these, 18% were over 65 years old and 45% were from academic centres. With increasing patient age and comorbidity, active surveillance and thermal ablative therapies were more the recommended treatment. Laparoscopic/robotic surgery was more commonly recommended by academic urologists and those under 65. Recommending surgery (radical nephrectomy or partial nephrectomy) for both elderly (about 80 years old) index patients correlated with surgeon age (surgeons over 65, p < 0.001), surgeons with no oncologic fellowship training (p = 0.021), surgeons with a non-academic practice (p = 0.003), surgeons with a personal history of cancer (p = 0.038) and surgeons with a family history of cancer death in the last 10 years (p = 0.022). CONCLUSIONS There are various factors that influence the management options offered to patients with SRMs. Our results suggest that surgeon age, personal history of cancer, practice-type and other surgeon-specific variables may affect treatments offered among urologists across Canada.
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Affiliation(s)
- Alexandra Leora Millman
- Division of Urology, Department of Surgery, St. Michael's Hospital, University of Toronto, Toronto, ON
| | - Kenneth T Pace
- Division of Urology, Department of Surgery, St. Michael's Hospital, University of Toronto, Toronto, ON
| | - Michael Ordon
- Division of Urology, Department of Surgery, St. Michael's Hospital, University of Toronto, Toronto, ON
| | - Jason Young Lee
- Division of Urology, Department of Surgery, St. Michael's Hospital, University of Toronto, Toronto, ON
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Klatte T, Kroeger N, Zimmermann U, Burchardt M, Belldegrun AS, Pantuck AJ. The contemporary role of ablative treatment approaches in the management of renal cell carcinoma (RCC): focus on radiofrequency ablation (RFA), high-intensity focused ultrasound (HIFU), and cryoablation. World J Urol 2014; 32:597-605. [PMID: 24700308 DOI: 10.1007/s00345-014-1284-7] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2013] [Accepted: 03/17/2014] [Indexed: 12/25/2022] Open
Abstract
INTRODUCTION Currently, most of renal tumors are small, low grade, with a slow growth rate, a low metastatic potential, and with up to 30 % of these tumors being benign on the final pathology. Moreover, they are often diagnosed in elderly patients with preexisting medical comorbidities in whom the underlying medical conditions may pose a greater risk of death than the small renal mass. Concerns regarding overdiagnosis and overtreatment of patients with indolent small renal tumors have led to an increasing interest in minimally invasive, ablative as an alternative to extirpative interventions for selected patients. OBJECTIVE To provide an overview about the state of the art in radiofrequency ablation (RFA), high-intensity focused ultrasound, and cryoablation in the clinical management of renal cell carcinoma. METHODS A PubMed wide the literature search of was conducted. RESULTS International consensus panels recommend ablative techniques in patients who are unfit for surgery, who are not considered candidates for or elect against elective surveillance, and who have small renal masses. The most often used techniques are cryoablation and RFA. These ablative techniques offer potentially curative outcomes while conferring several advantages over extirpative surgery, including improved patient procedural tolerance, faster recovery, preservation of renal function, and reduction in the risk of intraoperative and postsurgical complications. While it is likely that outcomes associated with ablative modalities will improve with further advances in technology, their application will expand to more elective indications as longer-term efficacy data become available. CONCLUSION Ablative techniques pose a valid treatment option in selected patients.
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Affiliation(s)
- Tobias Klatte
- Department of Urology, Medical University of Vienna, Vienna, Austria
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Chang X, Ji C, Zhao X, Zhang F, Lian H, Zhang S, Liu G, Zhang G, Gan W, Li X, Guo H. The Application of R.E.N.A.L. Nephrometry Scoring System in Predicting the Complications After Laparoscopic Renal Radiofrequency Ablation. J Endourol 2014; 28:424-9. [PMID: 24364623 DOI: 10.1089/end.2013.0497] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Affiliation(s)
- Xiaofeng Chang
- Department of Urology, The Affiliated Nanjing Drum Tower Hospital, Medical School of Nanjing University, Nanjing, China
| | - Changwei Ji
- Department of Urology, The Affiliated Nanjing Drum Tower Hospital, Medical School of Nanjing University, Nanjing, China
| | - Xiaozhi Zhao
- Department of Urology, The Affiliated Nanjing Drum Tower Hospital, Medical School of Nanjing University, Nanjing, China
| | - Fan Zhang
- Department of Urology, The Affiliated Nanjing Drum Tower Hospital, Medical School of Nanjing University, Nanjing, China
| | - Huibo Lian
- Department of Urology, The Affiliated Nanjing Drum Tower Hospital, Medical School of Nanjing University, Nanjing, China
| | - Shiwei Zhang
- Department of Urology, The Affiliated Nanjing Drum Tower Hospital, Medical School of Nanjing University, Nanjing, China
| | - Guangxiang Liu
- Department of Urology, The Affiliated Nanjing Drum Tower Hospital, Medical School of Nanjing University, Nanjing, China
| | - Gutian Zhang
- Department of Urology, The Affiliated Nanjing Drum Tower Hospital, Medical School of Nanjing University, Nanjing, China
| | - Weidong Gan
- Department of Urology, The Affiliated Nanjing Drum Tower Hospital, Medical School of Nanjing University, Nanjing, China
| | - Xiaogong Li
- Department of Urology, The Affiliated Nanjing Drum Tower Hospital, Medical School of Nanjing University, Nanjing, China
| | - Hongqian Guo
- Department of Urology, The Affiliated Nanjing Drum Tower Hospital, Medical School of Nanjing University, Nanjing, China
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