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Marchenko ES, Dubovikov KM, Kuzhelivskiy II, Pleshkov MO, Koroluk ES, Brazovskii KS, Volinsky AA. In vivo study of porous NiTi cryotweezers for bone tissue cryotherapy. Cryobiology 2024; 115:104894. [PMID: 38614237 DOI: 10.1016/j.cryobiol.2024.104894] [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: 12/25/2023] [Revised: 03/28/2024] [Accepted: 04/10/2024] [Indexed: 04/15/2024]
Abstract
This study examined the effects of liquid nitrogen vapor on osteogenesis in the rabbit femur. Cryotweezers made of porous nickel titanium alloy (nitinol or NiTi) obtained by self-propagating high temperature synthesis were used in this experiment. The porous structure of the cryotweezers allows them to hold up to 10 g of liquid nitrogen after being immersed for 2 min, which completely evaporates after 160 s. To study the effects of liquid nitrogen evaporation on osteogenesis, a rabbit femur was perforated. The formed holes were subjected to cryotherapy with varying exposure times. It was found that a 3 s exposure time stimulates osteogenesis, which was manifested in a greater number of osteoblasts in the regenerate compared to the control sample without liquid nitrogen. It was observed that increasing the exposure to 6, 9 or 12 s had a destructive effect, to varying degrees. The most severe damage was exerted by a 12 s exposure, which resulted in the formation of osteonecrosis areas. In the samples exposed to 6 and 9 s of cryotherapy, destruction of the cytoplasm of osteocytes and osteoclasts was observed.
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Affiliation(s)
- Ekaterina S Marchenko
- Laboratory of Superelastic Biointerfaces, National Research Tomsk State University, 36 Lenin Ave., 634045, Tomsk, Russia
| | - Kirill M Dubovikov
- Laboratory of Superelastic Biointerfaces, National Research Tomsk State University, 36 Lenin Ave., 634045, Tomsk, Russia
| | - Ivan I Kuzhelivskiy
- Department of Pediatric Surgical Diseases, Siberian State Medical University, 72 Olega Koshevogo Str., 634050, Tomsk, Russia
| | - Maksim O Pleshkov
- Laboratory "Bionic Digital Platforms", Siberian State Medical University, 2c7 Moskovsky Trakt, 634050, Tomsk, Russia
| | - Evgeniy S Koroluk
- Laboratory "Bionic Digital Platforms", Siberian State Medical University, 2c7 Moskovsky Trakt, 634050, Tomsk, Russia
| | - Konstantin S Brazovskii
- Division of Medical and Biological Cybernetics, Department of Biomedicine, Siberian State Medical University, 2 Moskovsky Trakt, 634050, Tomsk, Russia; Research School of Chemistry & Applied Biomedical Sciences, Tomsk Polytechnic University, Tomsk, Russia
| | - Alex A Volinsky
- Laboratory of Superelastic Biointerfaces, National Research Tomsk State University, 36 Lenin Ave., 634045, Tomsk, Russia; Department of Mechanical Engineering, University of South Florida, 4202 E. Fowler Ave. ENG030, Tampa, FL, 33620, USA.
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Attawettayanon W, Kazama A, Yasuda Y, Zhang JJH, Shah S, Rathi N, Munoz-Lopez C, Lewis K, Li J, Beksac AT, Campbell RA, Kaouk J, Haber GP, Weight C, Martin C, Campbell SC. Thermal Ablation Versus Partial Nephrectomy for cT1 Renal Mass in a Solitary Kidney: A Matched Cohort Comparative Analysis. Ann Surg Oncol 2024; 31:2133-2143. [PMID: 38071719 DOI: 10.1245/s10434-023-14646-2] [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: 08/07/2023] [Accepted: 11/09/2023] [Indexed: 02/08/2024]
Abstract
BACKGROUND Nephron-sparing approaches are preferred for renal mass in a solitary kidney (RMSK), with partial nephrectomy (PN) generally prioritized. Thermal ablation (TA) also is an option for small renal masses in this setting; however, comparative functional/survival outcomes are not well-defined. METHODS A retrospective study of 504 patients (1975-2022) with cT1 RMSK managed with PN (n = 409)/TA (n = 95) with necessary data for analysis was performed. Propensity score was used for matching patients, including age, preoperative glomerular filtration rate (GFR), tumor diameter, R.E.N.A.L. ((R)adius (tumor size as maximal diameter), (E)xophytic/endophytic properties of tumor, (N)earness of tumor deepest portion to collecting system or sinus, (A)nterior (a)/posterior (p) descriptor, and (L)ocation relative to polar lines), and comorbidities. Functional outcomes were compared, and Kaplan-Meier was used to analyze survival. RESULTS The matched cohort included 132 patients (TA = 66/PN = 66), with median tumor diameter of 2.4 cm, R.E.N.A.L. of 6, and preoperative GFR of 52 ml/min/1.73 m2. Acute kidney injury occurred in 11%/61% in the TA/PN cohorts, respectively (p < 0.01). After recovery, median GFR preserved was 89%/83% for TA/PN, respectively (p = 0.02), and 5-year dialysis-free survival was 96% in both cohorts. Median follow-up was 53 months. Five-year recurrence-free survival (RFS) was 62%/86% in the TA/PN cohorts, respectively (p < 0.01). Five-year local recurrence (LR)-free survival was 74%/95% in the TA/PN cohorts, respectively (p < 0.01). Five-year cancer-specific survival (CSS) was 96%/98% in the TA/PN cohorts, respectively (p = 0.7). Local recurrence was observed in nine of 36 (25%) and five of 30 (17%) patients managed with laparoscopic versus percutaneous TA, respectively. For TA with LR (n = 14), nine patients presented with multifocality and/or cT1b tumors. Twelve LR were managed with salvage TA, and seven remained cancer-free, while five developed systemic recurrence, three with concomitant LR. CONCLUSIONS Functional outcomes for TA for RMSK were improved compared with PN. Local recurrence was more common after TA and often was associated with the laparoscopic approach, multifocality, and large tumor size. Improved patient selection and greater experience with TA should improve outcomes. Salvage of LR was not always possible. Partial nephrectomy remains the reference standard for RMSK.
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Affiliation(s)
- Worapat Attawettayanon
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA
- Division of Urology, Department of Surgery, Faculty of Medicine, Songklanagarind Hospital, Prince of Songkla University, Songkhla, Thailand
| | - Akira Kazama
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA
- Department of Urology, Molecular Oncology, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Yosuke Yasuda
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA
- Graduate School, Tokyo Medical and Dental University, Tokyo, Japan
| | - J J H Zhang
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA
- Department of Urology, University of California Los Angeles (UCLA), Los Angeles, CA, USA
| | - Snehi Shah
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Nityam Rathi
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Carlos Munoz-Lopez
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Kieran Lewis
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Jianbo Li
- Department of Quantitative Health Sciences, Lerner Research Institute, Cleveland, OH, USA
| | - Alp T Beksac
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Rebecca A Campbell
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Jihad Kaouk
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA
| | | | - Christopher Weight
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Charles Martin
- Department of Interventional Radiology, Cleveland Clinic, Cleveland, OH, USA
| | - Steven C Campbell
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA.
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Knudsen JS, Duus LA, Junker T, Mussmann B, Graumann O. Percutaneous Renal Tumor Cryoablation Effect on Renal Function. J Endourol 2023; 37:1149-1155. [PMID: 37578120 DOI: 10.1089/end.2021.0959] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/15/2023] Open
Abstract
Background: Percutaneous cryoablation (PCA) of renal tumors is a well-established alternative to partial nephrectomy, but the effects on renal function after the procedure are not well-documented. The purpose of this study was to evaluate renal function after computed tomography-guided PCA. Materials and Methods: A retrospective cohort study including 259 patients treated with PCA at Odense University Hospital, Denmark from January 1, 2015 to December 31, 2019. Both patients with malignant (96%) and benign tumors (4%) were included. Mean age of patients was 66.5 years (standard deviation [SD] = 10.9, range: 27-91) and 174 (67%) patients were men. Baseline estimated glomerular filtration rate (eGFR) was recorded at baseline and 12 months after cryoablation. Results: Mean tumor size was 27.5 mm (SD = 10.0) distributed in seven different histopathological types, mainly clear cell renal-cell carcinoma (RCC) (64%) and papillary RCC (22%). Mean eGFR at baseline was 73.7 mL/min/1.73 m2 (SD = 23.2) with a follow-up mean eGFR of 69.7 (SD = 23.7) (p < 0.0001). At baseline before intervention 190 patients (73%) had eGFR matching chronic kidney disease (CKD) groups 1 and 2 (normal to mild CKD), 64 patients (24%) matching CKD group 3 (average CKD), and 1% in groups 4 and 5. At 12-month follow-up, 171 patients (66%) had eGFR matching CKD groups 1 and 2, 77 patients (30%) matching CKD group 3 and 11 patients (4%) matching CKD groups 4 and 5. In patients with skewed renography who had PCA in the kidney with better excretion, eGFR at baseline was 64.7 and 61.2 at follow-up (p = 0.703). Conclusions: This study showed minimal decline in renal function 12 months after PCA, even for patients with reduced renal function. PCA is therefore considered a safe and relevant intervention.
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Affiliation(s)
- Jens Steensen Knudsen
- Department of Medicine, Faculty of Health Sciences, University of Southern Denmark (SDU), Odense, Denmark
- Research and Innovation Unit of Radiology, SDU, Odense, Denmark
| | - Louise Aarup Duus
- Research and Innovation Unit of Radiology, SDU, Odense, Denmark
- Department of Radiology, OUH, Odense, Denmark
| | - Theresa Junker
- Research and Innovation Unit of Radiology, SDU, Odense, Denmark
| | - Bo Mussmann
- Research and Innovation Unit of Radiology, SDU, Odense, Denmark
- Department of Radiology, OUH, Odense, Denmark
- Department of Health Sciences, Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway
| | - Ole Graumann
- Research and Innovation Unit of Radiology, SDU, Odense, Denmark
- Department of Radiology, OUH, Odense, Denmark
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Yim K, Leeman JE. Radiation Therapy in the Treatment of Localized and Advanced Renal Cancer. Urol Clin North Am 2023; 50:325-334. [PMID: 36948675 DOI: 10.1016/j.ucl.2023.01.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/22/2023]
Abstract
Renal cell carcinoma (RCC) has historically been considered resistant to radiotherapy. However, advances in the field of radiation oncology have led to safe delivery of higher radiation doses through the use of stereotactic body radiotherapy (SBRT) that have shown significant activity against RCC. SBRT has now been shown to be a highly effective modality for management of localized RCC for nonsurgical candidates. Increasing evidence also points to a role for SBRT in the management of oligometastatic RCC as a means for not only providing palliation but prolonging time to progression and potentially improving survival.
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Affiliation(s)
- Kendrick Yim
- Division of Urology, Brigham and Women's Hospital, 45 Francis Street, Boston, MA 02215, USA
| | - Jonathan E Leeman
- Department of Radiation Oncology, Dana Farber Cancer Institute/ Brigham and Women's Hospital, Boston, MA, USA.
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Chen Z, Meng L, Zhang J, Zhang X. Progress in the cryoablation and cryoimmunotherapy for tumor. Front Immunol 2023; 14:1094009. [PMID: 36761748 PMCID: PMC9907027 DOI: 10.3389/fimmu.2023.1094009] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Accepted: 01/09/2023] [Indexed: 01/26/2023] Open
Abstract
With the rapid advancement of imaging equipment and minimally invasive technology, cryoablation technology is being used more frequently in minimally invasive treatment of tumors, primarily for patients with early tumors who voluntarily consent to ablation as well as those with advanced tumors that cannot be surgically removed or cannot be tolerated. Cryoablation is more effective and secure for target lesions than other thermal ablation methods like microwave and radiofrequency ablation (RFA). The study also discovered that cryoablation, in addition to causing tumor tissue necrosis and apoptosis, can facilitate the release of tumor-derived autoantigens into the bloodstream and activate the host immune system to elicit beneficial anti-tumor immunological responses against primary. This may result in regression of the primary tumor and distant metastasis. The additional effect called " Accompanying effects ". It is the basis of combined ablation and immunotherapy for tumor. At present, there is a lot of research on the mechanism of immune response induced by cryoablation. Trying to solve the question: how positively induce immune response. In this review, we focus on: 1. the immune effects induced by cryoablation. 2. the effect and mechanism of tumor immunotherapy combined with cryoablation. 3.The clinical research of this combination therapy in the treatment of tumors.
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Affiliation(s)
- Zenan Chen
- Department of Radiology, The First Medical Center, Chinese People's Liberation Army (PLA) General Hospital, Beijing, China
| | - Liangliang Meng
- Department of Radiology, The First Medical Center, Chinese People's Liberation Army (PLA) General Hospital, Beijing, China.,Department of Radiology, Chinese People's Armed Police (PAP) Force Hospital of Beijing, Beijing, China
| | - Jing Zhang
- Department of Radiology, The First Medical Center, Chinese People's Liberation Army (PLA) General Hospital, Beijing, China
| | - Xiao Zhang
- Department of Radiology, The First Medical Center, Chinese People's Liberation Army (PLA) General Hospital, Beijing, China
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Beksac AT, Corrigan D, Abou Zeinab M, Ferguson E, Kaviani A, Schwen ZR, Kaouk JH. Long-term comparative outcomes of partial nephrectomy and cryoablation in patients with solitary kidneys: a single-center analysis. Minerva Urol Nephrol 2022; 74:722-729. [PMID: 35622349 DOI: 10.23736/s2724-6051.22.04840-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
BACKGROUND Patients with solitary kidneys are amenable to postoperative acute kidney injury (AKI) after PN. We compared the functional and oncological outcomes of cryoablation (CA) and PN in patients with a solitary kidney and a cT1a renal mass. METHODS From a single-institution series, we analyzed 74 patients (31 PN, 43 CA) with a solitary kidney who underwent treatment for a cT1a renal mass. The functional outcomes were AKI and estimated glomerular filtration rate (eGFR) preservation. Oncological outcomes were recurrence and death. Linear mixed-effects and logistic regression models were used for functional outcomes analysis, whereas oncological outcomes were analyzed using the Kaplan-Meier method. RESULTS Median follow-up was 63.9 months. PN group had lower median age (59 years vs. 68, P<0.001) and larger median tumor size (2.80 cm vs. 2.0, p =0.003). AKI was more common in the PN group on postoperative day 1 (58% vs. 2.8%, P<0.001). However, only one patient in the PN group required temporary dialysis in the perioperative period. eGFR preservation was similar at postoperative 3 months (89% vs. 90%, P=0.083), or 12 months (85% vs. 94%, P=0.2) follow-up. CA group had higher recurrence rate (29% vs. 3.2%, P=0.005), and worse recurrence-free survival (P=0.027). Overall survival (OS) was comparable (P=0.31). CONCLUSIONS In a solitary kidney setting, CA is associated with a lower risk of AKI at postoperative day 1 compared to PN. Functional outcome is comparable upon longer follow-up. The local recurrence rates are significantly higher in the CA group with no significant difference in OS.
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Affiliation(s)
- Alp T Beksac
- Glickman Urological and Kidney Institute, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Dillon Corrigan
- Glickman Urological and Kidney Institute, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Mahmoud Abou Zeinab
- Glickman Urological and Kidney Institute, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Ethan Ferguson
- Glickman Urological and Kidney Institute, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Aaron Kaviani
- Glickman Urological and Kidney Institute, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Zeyad R Schwen
- Glickman Urological and Kidney Institute, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Jihad H Kaouk
- Glickman Urological and Kidney Institute, Cleveland Clinic Foundation, Cleveland, OH, USA -
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Assessing Trifecta Achievement after Percutaneous Cryoablation of Small Renal Masses: Results from a Multi-Institutional Collaboration. MEDICINA (KAUNAS, LITHUANIA) 2022; 58:medicina58081041. [PMID: 36013508 PMCID: PMC9412454 DOI: 10.3390/medicina58081041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 07/28/2022] [Accepted: 08/01/2022] [Indexed: 11/17/2022]
Abstract
Background and Objectives: To assess efficacy and safety of Percutaneous Cryoablation (PCA) of small renal masses (SRMs) using Trifecta outcomes in a large cohort of patients who were not eligible for surgery. Materials and methods: All PCAs performed in four different centers between September 2009 and September 2019 were retrospectively evaluated. Patients were divided in two different groups depending on masses dimensional criteria: Group-A: diameter ≤ 25 mm and Group-B: diameter > 25 mm. Complications rates were reported and classified according to the Clavien−Dindo system. The estimate glomerular filtration rate (eGFR) was calculated before PCA and during follow-up schedule. Every patient received a Contrast Enhanced Ultrasound (CEUS) evaluation on the first postoperative day. Radiological follow-up was taken at 3, 6, and 12 months for the first year, then yearly. Radiological recurrence was defined as a contrast enhancement persistence and was reported in the study. Finally, Trifecta outcome, which included complications, RFS, and preservation of eGFR class, was calculated for every procedure at a median follow-up of 32 months. Results: The median age of the patients was 74 years. Group-A included 200 procedures while Group-B included 140. Seventy-eight patients were eligible for Trifecta evaluation. Trifecta was achieved in 69.6% of procedures in Group-A, 40.6% in Group-B (p = 0.02). We observed an increased rate of complication in Group-B (13.0% vs. 28.6; p < 0.001). However, 97.5% were <II Clavien−Dindo grade. No differences were found between the two groups regarding eGFR before and after treatment. Further, 24-months RFS rates were respectively 98.0% for Group-A and 92.1% in Group-B, while at 36 months were respectively 94.5% and 87.5% (p = 0.08). Conclusions: PCA seems to be a safe and effective treatment for SRM but in the need of more strict dimensional criteria to achieve a higher possible success rate.
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Li L, Zeng X, Yang C, Un W, Hu Z. Three-dimensional (3D) reconstruction and navigation in robotic-assisted partial nephrectomy (RAPN) for renal masses in the solitary kidney: A comparative study. Int J Med Robot 2021; 18:e2337. [PMID: 34591353 DOI: 10.1002/rcs.2337] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Revised: 09/02/2021] [Accepted: 09/22/2021] [Indexed: 12/15/2022]
Abstract
BACKGROUND Numerous efforts were made to improve renal function and oncologic outcomes in surgery for patients with kidney cancer. We explored new robotic methods in solitary kidneys. MATERIALS AND METHODS We prospectively registered and included 16 patients in the 3D-robot-assisted partial nephrectomy (RAPN) group with a solitary kidney (anatomic or functional), and retrospectively identified 25 patients with a solitary kidney who received RAPN also operated by us for comparison. RESULTS The rates of global clamping reduced in the 3D-RAPN group (37.5% vs 76%)while selective rates were higher (56.2% vs 20%) (p = 0.028). The mean percentages of Scr increase (+20.2% vs +30.2%, p = 0.045) and eGFR reduction (-16.8% vs -27.1%) as well as rate of opening collecting systems (31.3% vs 72%, p = 0.010) were lower in 3D-RAPN group. CONCLUSIONS 3D-RAPN less impaired the renal function of patients with a solitary kidney and showed superiority or non-inferiority in other evaluation indexes compared to conventional RAPN.
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Affiliation(s)
- Le Li
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xing Zeng
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Chunguang Yang
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Waikeong Un
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Zhiquan Hu
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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Henderickx MMEL, Sträter-Ruiter AEC, van der West AE, Beerlage HP, Zondervan PJ, Lagerveld BW. Laparoscopic cryoablation for small renal masses: Oncological outcomes at 5-year follow-up. Arab J Urol 2020; 19:159-165. [PMID: 34104491 PMCID: PMC8158258 DOI: 10.1080/2090598x.2020.1863308] [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: 11/10/2022] Open
Abstract
Objective: To evaluate the oncological outcome at 5-year follow-up after laparoscopic cryoablation (LCA) for small renal masses (SRMs), as there is an increasing interest in ablative therapy for cT1a renal tumours due to the rising incidence of SRMs, the trend towards minimally invasive nephron-sparing treatments, and the ageing population. Patients and methods: Between 2004 and 2015, 233 consecutive LCA were performed in 219 patients for SRMs at two referral centres. We only included those patients with ≥5 years of follow-up (n = 165) in a prospectively maintained database. A descriptive analysis was conducted for pre-, peri- and postoperative characteristics. A Kaplan–Meier analysis assessed overall (OS), disease-specific (DSS), and recurrence-free survival (RFS). Results: The median (interquartile range [IQR]) age of our patient cohort was 68 (60.5–76) years. The median (IQR) body mass index was 26.2 (23.8–29) kg/m2, and the median (IQR) Charlson Comorbidity Index score corrected for age was 4 (2.5–6). The median (IQR) tumour diameter was 28 (21–33) mm. In all, 15% developed a complication in the first 30 days after LCA, of which 1% had a major complication (Clavien–Dindo Grade ≥III). The median (IQR) preoperative estimated glomerular filtration rate (eGFR) was 82.5 (65–93.75) mL/min/1.73 m2. The median eGFR decreased by 16.4% and 15.2% at the 3-month and 5-year follow-up, respectively. Persistence was found in 1%, local recurrence in 2%, and systemic progression in 4%. The OS, DSS, and RFS were 74%, 96.9% and 95.4%, respectively. Conclusion: LCA is a safe and effective treatment for SRMs in selected cases and shows good oncological outcomes after 5 years of follow-up, with only 1% developing a major complication.
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Affiliation(s)
- Michaël M E L Henderickx
- Department of Urology, Amsterdam University Medical Centers (Amsterdam UMC), University of Amsterdam, Amsterdam, The Netherlands
| | | | - Alwine E van der West
- Department of Urology, Amsterdam University Medical Centers (Amsterdam UMC), University of Amsterdam, Amsterdam, The Netherlands
| | - Harrie P Beerlage
- Department of Urology, Amsterdam University Medical Centers (Amsterdam UMC), University of Amsterdam, Amsterdam, The Netherlands
| | - Patricia J Zondervan
- Department of Urology, Amsterdam University Medical Centers (Amsterdam UMC), University of Amsterdam, Amsterdam, The Netherlands
| | - Brunolf W Lagerveld
- Department of Urology, Onze Lieve Vrouwe Gasthuis (OLVG), Amsterdam, The Netherlands
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10
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Nielsen TK, Vedel PF, Borgbjerg J, Andersen G, Borre M. Renal cryoablation: five- and 10-year survival outcomes in patients with biopsy-proven renal cell carcinoma. Scand J Urol 2020; 54:408-412. [PMID: 32700594 DOI: 10.1080/21681805.2020.1794954] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
OBJECTIVE To investigate the long-term oncological efficacy of renal cryoablation (CA) of small renal tumors. MATERIALS AND METHODS A review of patients treated with CA for a biopsy confirmed renal cell carcinoma less than 4 cm in diameter. All patients were identified from a prospectively maintained clinical database. Treatment efficacy was computed using the Kaplan-Meier method to estimate disease-free survival (DFS) and overall survival rates (OS). RESULTS A total of 179 patients (116 men and 63 women) with a mean age of 64 years (95% CI = 63 - 66) were included in the analysis. Mean tumor size was 27 mm (95% CI = 25.5-28.0) with a low, moderate and high PADUA complexity score in 30.2%, 44.7% and 16.2% of the cases, respectively. A total of 19 patients (11%) were diagnosed with residual unablated tumor, six patients (3%) were diagnosed with late local recurrence and six patients (3%) were diagnosed with metastatic disease. The estimated 5 years image confirmed the DFS rate was 79% (95% CI = 70-85). The estimated 5- and 10-year OS rates were 82% (95% CI = 75-87) and 61% (95% CI = 48-71), respectively. During the 10-year follow-up period a total of five patients (3%) died due to renal cancer, while 46 patients (26%) died from other causes. CONCLUSIONS CA appears to be an effective treatment modality for patients with small renal tumors. The present study demonstrated low rates of local recurrence and disease progression with excellent long-term cancer-specific survival.
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Affiliation(s)
| | | | - Jens Borgbjerg
- Department of Radiology, Aarhus University Hospital, Aarhus, Denmark
| | - Gratien Andersen
- Department of Radiology, Aarhus University Hospital, Aarhus, Denmark
| | - Michael Borre
- Department of Urology, Aarhus University Hospital, Aarhus, Denmark
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