Cryoablation for recurrent renal tumors after primary nephron-sparing surgery using an innovative liquid nitrogen-based cryogenic device

Abstract

The growing use and improvement of imaging modalities has resulted in increased detection of renal tumors. The gold standard treatment of small renal masses is nephron-sparing surgery. Such surgical intervention is associated with significant rate of local failure. The currently accepted treatment for local failure after nephron-sparing surgery is radical nephrectomy which is associated with very high complication rate as well as loss of functional renal parenchyma. The aim of the current study was to evaluate the safety, technical feasibility, oncologic success and functional preservation of percutaneous cryoablation using a new liquid nitrogen-based cryogenic device in patients with tumor recurrence after nephron-sparing surgery. We present seven patients with tumor recurrence after nephron-sparing surgery who underwent percutaneous cryoablation using ProSense™ (IceCure Medical Ltd, Caesarea, Israel) under computerized tomography guidance. None of the treated tumor lesions demonstrated contrast enhancement or growth on follow up imaging indicating a 100% oncologic success. Only three adverse events were recorded, all were classified as low grade and resolved spontaneously. In conclusion, percutaneous cryoablation using the novel ProSense™ device for recurrent renal tumors following nephron-sparing surgery is feasible and effective, with excellent renal function preservation and without major complications.

Percutaneous treatment of renal tumours

“…In the literature, there are also liquid nitrogen-based systems. 25 Tissue destruction occurs by freezing, causing crystallization of cytoplasmic fluid, and thawing which melts the crystallized fluid resulting in rupture of cell membranes and cellular dehydration. 26,27 Cryoablation causes microvascular thrombosis that can also lead to cell death.…”

“…Current cryoablation tools are argon‐based systems that use the Joules‐Thompson principle to create an ice‐ball. In the literature, there are also liquid nitrogen‐based systems 25 . Tissue destruction occurs by freezing, causing crystallization of cytoplasmic fluid, and thawing which melts the crystallized fluid resulting in rupture of cell membranes and cellular dehydration 26,27 .…”