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Cryoablation of cT1 Renal Masses in “Healthier” Patients: Early Outcomes from Mayo Clinic  

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Sources of Funding: None.

Introduction

Current guidelines suggest that percutaneous thermal ablation (PTA) can be utilized in those with significant comorbidity who are unable to tolerate surgery (radical or partial nephrectomy). However, the use of PTA in "healthier" patients, who are otherwise candidates for surgery, has been limited. Here, we reviewed our institutional experience in such patients electing to undergo PTA, specifically cryoablation.

Methods

We identified patients ≤65 years undergoing percutaneous cryoablation for solitary, non-metastatic renal masses <7cm (cT1). We further limited our cohort to patients with an ASA score of 1 or 2, and in whom pre-operative eGFR was >60. Clincopathologic characteristics and recurrence patterns (local recurrence within the kidney versus metastatic disease) were evaluated.

Results

Between March 2003 and December 2015, 705 patients underwent cryoablation, of whom 43 (6.1%) met inclusion criteria. Median age of this cohort was 57 years (IQR 52-62), with pre-ablation eGFR of 75.6 (IQR 69.0-86.3) (Table). 14 (32.6%), 19 (44.2%), and 10 (23.2%) patients reported zero, one, or multiple prior abdominal-pelvic surgeries, respectively. Five patients (11.6%) had a prior partial nephrectomy. The majority (40, 93.0%) of ablated masses were cT1a, with 3 (7.0%) being cT1b. Median tumor size was 2.0 cm. 27 masses (63.7%) were biopsy-proven renal cell carcinoma (RCC) and 6 (13.6%) were benign; histology was unknown in 10 (22.7%). Follow-up imaging was available for 37 patients. Median radiological follow-up was 22 months (IQR 9-42), during which time 2 patients developed metastatic disease and and 1 developed local recurrence; all events were in patients with biopsy-proven RCC. No patients died from RCC during this time period. _x000D_

Conclusions

In this single institution cohort of "healthier" patients with cT1 solitary renal masses, cryoablation offered reasonable short term oncologic control. While longer follow-up data are needed to evaluate for durability, cryoablation in healthier patients, particularly those with challenging surgical anatomy or prior renal surgery, warrants further study.

Funding

None.

Authors
Harras Zaid
Thomas Atwell
Grant Schmit
Stephen Boorjian
William Parker
John Cheville
Bradley Leibovich
R. Houston Thompson
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