Clinical Outcomes of Patients With Nondiagnostic Biopsy During Cryoablation of Small Renal Masses

Current Status of Focal Cryoablation for Small Renal Masses

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.

Kidney cancer focal cryoablation trend: does location or approach matter?

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.