Assessing Trifecta Achievement after Percutaneous Cryoablation of Small Renal Masses: Results from a Multi-Institutional Collaboration

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.

Cryoablation and Immunotherapy: An Enthralling Synergy for Cancer Treatment

“…Recent studies, such as [58][59][60][61], favored the percutaneous cryoablation over the partial nephrectomy in RCC stage cT1, especially for older people with low physical and role functional ratings and those who cannot undergo a surgical procedure. As well, [59,[61][62][63] demonstrated the role of cryoablation in reducing complications and mortality, improving the oncological results and renal function after surgery, especially in the case of endophytic renal masses [62]. Furthermore, ref.…”

The Impact of COVID-19 on New Kidney Cancer Diagnosis: Stage and Treatment in Northern Italy

“…Among the study’s limitations, we recall a need for more information on surgical schedule delays and even on survival, considering the short follow-up time. Information on specific treatments, such as cryoablation, could help in evaluating the impact of COVID-19 on surgery, as highlighted in a recent Italian work [ 49 ]. However, we could not address the issue since no cryoablation treatments were carried out in our province.…”

“Could Patient Age and Gender, along with Mass Size, Be Predictive Factors for Benign Kidney Tumors?”: A Retrospective Analysis of 307 Consecutive Single Renal Masses Treated with Partial or Radical Nephrectomy

“…These data highlight the relevance of the careful employment of these surgical treatments [45]. However, according to Andrea Piasentin et al [46], percutaneous cryoablation (PCA) can cause killing tumoral cells together with preserving renal function and reducing procedural-related morbidity (the so-called "Trifecta"). In this multi-institutional series, they found that PCA is more likely to achieve good outcomes measured by Trifecta in masses < 2.5 cm than in the bigger one.…”