Percutaneous cryoablation of kidney tumors after partial nephrectomy

Abstract

Introduction: The widespread use of ultrasound and cross-sectional imaging has led to a steady increase in the incidental discovery of renal masses. Most of them are treated with partial nephrectomy (PN), as recommended by the European Association of Urology guidelines. However, this approach carries a risk of local recurrence. In such a case, surgical reintervention can be more challenging and is often associated with worse prognosis. In this context, percutaneous ablative therapies are a promising alternative. Aim: This study presents our experience with using percutaneous cryoablation (PCA) to manage recurrences and new masses in previously operated kidneys. Materials and methods: We conducted a retrospective data analysis to evaluate patients treated with PCA for tumor recurrence or residual disease in the postresection bed, excluding those with de novo or recurrent tumors in the contralateral kidney. Results: A total of 23 individuals met the inclusion criteria. Of those, 14 initially underwent laparoscopic PN, and 9 were treated with open surgery. The median interval from the initial surgery to recurrence-targeted PCA was 23 months (range, 7–228). The mean (SD) RENAL score on admission was 7.5 (1.9), and the median (interquartile range) tumor volume was 3 (1.6–4.5) ml. The median length of hospital stay was 23 hours (range, 6–55). There was no significant change in estimated glomerular filtration rate following cryoablation. All the recorded complications, except one, were grade I and resolved with hydration or treatment with nonsteroidal anti-inflammatory drugs. No patient required dialysis in the perioperative period. Conclusions: Imaging-guided PCA is a feasible and effective treatment option for patients with renal tumor recurrences after PN.

Keywords

• ablative therapy
• percutaneous cryoablation
• recurrence
• renal cell carcinoma
• renal cryoablation