Safety and Technical Feasibility of Percutaneous Renal Cryoablation of Central Tumors without Pyeloperfusion

J Vasc Interv Radiol. 2024 Apr;35(4):533-540. doi: 10.1016/j.jvir.2024.01.006. Epub 2024 Jan 12.

Abstract

Purpose: To assess the safety and technical success of percutaneous cryoablation (PCA) without pyeloperfusion in 94 patients with central renal tumors.

Materials and methods: A retrospective review of all central renal tumors treated by PCA without pyeloperfusion was performed. Central tumors were defined as those involving the renal sinus fat on preprocedural cross-sectional imaging. Patient demographics and baseline tumor characteristics were recorded. The details of the PCA procedure, primary and secondary technical success, rates of local recurrence, adverse events (AEs), cancer-specific survival (CSS), and overall survival (OS) were compiled.

Results: Ninety-four patients (48 females [51%]; mean age, 68.2 years [range, 38-87 years]) with 94 central renal tumors were included. The mean maximal tumor diameter and mean RENAL nephrometry score were 37 mm (range, 15-67 mm) and 8 (range, 4-11), respectively. Primary technical success was achieved in 94% (n = 88) of procedures. Of the patients who did not achieve primary technical success, 3 underwent successful repeat PCA (secondary technical success, 97%; n = 91/94). The other 3 patients were surveilled for residual disease. Twenty-four patients (26%) required hydrodissection during PCA. Six patients (6%) experienced major AEs after PCA including hemorrhage requiring embolization (n = 3), hemorrhage requiring transfusions with admission (n = 2), and perinephric abscess necessitating drain placement (n = 1). Twenty-two patients (23%) experienced minor AEs. Nine patients (10%) experienced local recurrence during the follow-up period. OS was 94% (n = 88/94), whereas CSS was 98% (n = 92/94) during the study follow-up period (mean, 16 months [range, 1-102 months]).

Conclusions: PCA of central renal tumors appears to be safe with high rates of technical success, even without the use of pyeloperfusion.

MeSH terms

  • Aged
  • Carcinoma, Renal Cell* / surgery
  • Cryosurgery* / adverse effects
  • Cryosurgery* / methods
  • Feasibility Studies
  • Female
  • Hemorrhage / etiology
  • Humans
  • Kidney Neoplasms* / diagnostic imaging
  • Kidney Neoplasms* / surgery
  • Retrospective Studies
  • Treatment Outcome