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ORIGINAL ARTICLE   Free accessfree

Minerva Urology and Nephrology 2021 August;73(4):518-24

DOI: 10.23736/S2724-6051.21.04015-5


lingua: Inglese

Percutaneous cryoablation for high-complexity renal masses: complications, functional and oncological outcomes

Michele RIZZO 1 , Andrea PIASENTIN 1, Giacomo REBEZ 1, Gianluca GIANNARINI 2, Paolo UMARI 3, Camilla SACHS 4, Antonio CELIA 5, Nicola PAVAN 1, Luca BALESTRIERI 6, Giorgio ARTUSO 7, Michele BERTOLOTTO 4, Carlo TROMBETTA 1, Giovanni LIGUORI 1

1 Department of Urology, Surgery and Health Science, University of Trieste, Trieste, Italy; 2 Department of Urology, Santa Maria della Misericordia Hospital, Udine, Italy; 3 Department of Surgery, Clinic of Urology, University of Eastern Piedmont, Novara, Italy; 4 Department of Radiology, University of Trieste, Trieste, Italy; 5 ULSS 7 Pedemontana, Bassano del Grappa, Vicenza, Italy; 6 Department of Urology, Aviano, Pordenone, Italy; 7 Department of Urology, ULSS 3 Serenissima, Dolo, Venezia, Italy

BACKGROUND: During the past two decades cryoablation (CA) has become a therapeutic option for the management of localized cT1 renal masses in comorbid patients. We analyzed the mid-term functional and oncological outcomes of CA in the treatment of cT1 renal masses which were classified as high-complexity masses according to the PADUA system.
METHODS: A total of 299 patients underwent percutaneous CA between November 2007 and December 2018 in 4 institutions for cT1N0M0 renal masses. All patients with high-complexity (PADUA≥10) renal tumors were included. Technical failure of CA was considered an exclusion criterion.
RESULTS: Inclusion criteria were met by 45 patients. Median Charlson Comorbidity Index (CCI) was 6.0 (IQR: 5.0-7.0), median age was 74 years (IQR: 64.5-79.5). Seven Clavien 1 and 1 Clavien 2 procedure-related complications were reported. Median eGFR at baseline was 64.3mL/min (IQR: 52.0-82.3) while at the 1-year follow-up was 61.4 mL/min (IQR: 44.0-74.5). The median follow-up was 32 months (IQR: 13.25-47.5). Local recurrences were detected in 6 patients; 3 of them underwent re-cryoablation while the others started active surveillance. Median time to recurrence was 17.5 months (IQR: 7.8-27.3). Cancer-specific survival and metastasis-free survival were 100%, while overall survival was 86.7%.
CONCLUSIONS: CA proved to be a valuable therapeutic option for the management of patients with cT1 high-complexity PADUA≥10 renal tumors as it provides a low rate of procedural morbidity and good preservation of renal function. However, these results are counterbalanced by a recurrence rate that appears to be higher than those reported on surgically treated patients.

KEY WORDS: Kidney neoplasms; Cryosurgery; Neoplasm recurrence, local; Carcinoma, renal cell

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