Review of the efficacy and safety of cryoablation for the treatment of small renal masses

Kapoor, Anil; Touma, Naji J.; Dib, Regina El

doi:10.5489/cuaj.193

Cited by 13 publications

(7 citation statements)

References 27 publications

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“…Ideally, ablative treatment should be compared with partial nephrectomy (PN) in a randomized and prospective setting. Nephron-sparing surgery in multiple renal cancer: a case report for Adverse Events grading system [14]. Sprenkle et al reported complications rate of 13% approximately as well [15].…”

Section: Discussionmentioning

confidence: 99%

Nephron-sparing surgery in multiple renal cancer: a case report

Regis

Mauro

Russo

et al. 2017

CMI

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BACKGROUND: In the last decade, nephron-sparing surgery has largely supplanted the radical approach for the treatment of small renal masses. More recently, ablative technologies have been discussed as alternative in patients that are not eligible for surgical approach.CASE SUMMARY: A 54-year-old Caucasian man was referred to our Urology Clinic for multiple renal masses. A computed tomography (CT) scan revealed three contrast-enhanced lesions located in the upper pole, middle renal, and in the lower pole of the left kidney 20 mm, 25 mm, and 45 mm long, respectively. The patient underwent laparoscopic tumorectomy of two lesions and cryoablation of the left renal mass by the transperitoneal approach, performed without clamping the renal vessels. At the end of the procedure the operator posed a reno-ureteral ipsilateral stent to tutor the urinary tract. Tumor enucleation and cryoablation were chosen to preserve renal function.CONCLUSION: This case report shows that in young patients with multiple renal tumors, cryoablation treatment is feasible and outcomes are promising as well. However, risk of complications should be considered and discussed with patients.

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Section: Discussionmentioning

confidence: 99%

Nephron-sparing surgery in multiple renal cancer: a case report

Regis

Mauro

Russo

et al. 2017

CMI

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“…1,2 In Europe, an estimated 84 400 new cases of renal cell carcinomas are diagnosed each year with more than 60% of these being T1a tumors, thus amenable for nephron-sparing surgery. [3][4][5] The current gold standard for treating SRMs is partial nephrectomy (PN) as stated by both European Association of Urology and American Urology Association.…”

Section: Introductionmentioning

confidence: 99%

“…When it comes to oncological outcome, CA is generally considered less effective compared to radical nephrectomy or PN. 1,[5][6][7][8][9][10] However, direct comparison of the 2 modalities is difficult due to selection biases and confounding. In addition, long-term data are still very sparse when it comes to CA and PN.…”

Section: Introductionmentioning

confidence: 99%

Arterial Clamping Increases Central Renal Cryoablation Efficacy: An Animal Study

Nonboe

Nielsen

Høyer

et al. 2016

Technol Cancer Res Treat

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Introduction: The minimally invasive treatment of small renal masses with cryoablation has become increasingly widespread during the past 15 years. Studies with long-term follow-up are beginning to emerge, showing good oncological control, however, tumors with a central and endophytic location seem to possess an increased risk of treatment failure. Such tumors are likely to be subjected to a high volume of blood giving thermal protection to the cancerous cells. Arterial clamping during freezing might reduce this effect but at the same time subject the kidney to ischemia. The aim of this study was to evaluate the effect of renal artery clamping during cryoablation in a porcine survival model. Methods: Ten Danish Landrace pigs (approximately 40 kg) underwent bilateral laparoscopic cryoablation with clamping of the right renal artery during freezing. The cryoablation consisted of a standard doublefreeze cycle of 10-minute freeze followed by 8 minutes of thaw. Arterial clamping subjected the right kidney to 2 cycles of ischemia (10 minutes) with perfusion in between. After surgery, the animals were housed for 14 days prior to computed tomography perfusions scans, radioisotope renography, and bilateral nephrectomy. Results: No perioperative or postoperative complications were experienced. Mean differential renal function was 44% (95% confidence interval: 42-46) in the clamped right kidney group and 56% (95% confidence interval: 54-58) in the nonclamped left kidney group, P < .05. The +5% technical inaccuracy is not accounted for in the results. Mean maximum temperature between freeze cycles was 5.13 C (95% confidence interval: À0.1 to 10.3) in the clamped right kidney group and 22.7 C (95% confidence interval: À16.6 to 28.8) in the nonclamped left kidney group, P < .05. Mean cryolesion volume, estimated on computed tomography perfusion, was 12.4 mL (95% confidence interval: 10.35-14.4) in the clamped right kidney group and 6.85 mL (95% confidence interval: 5.57-8.14) in the nonclamped left kidney group, P < .05. Pathological examination shows a higher degree of vital cells in the intermediate zone of the cryolesions in the nonclamped left kidneys when compared with the clamped right kidneys. Conclusion: Arterial clamping increases cryolesion size by approximately 80%, and pathologic examinations suggest a decreased risk of vital cells in the intermediate zone. The clamped kidneys showed no sign of injury from the limited ischemic insult. This study was limited by being a nontumor model.

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“…Microwave ablation and high-intensity focused ultrasound have also been trialled but are less widely available. Data regarding these emerging modalities is diffi cult to interpret because of lack of pre-procedural biopsy confi rming a malignant lesion, wide variability in the defi nition of oncological outcomes and lack of long-term follow-up (Kapoor et al 2013 ). Both RFA and cryoablation can be performed percutaneously under imaging guidance or laparoscopically.…”

Section: Focal Therapymentioning

confidence: 99%

Female Pelvis: Genital Organs

Forstner

Cunha²

2015

Imaging of Complications and Toxicity Following Tumor Therapy

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Medical Radiology-Diagnostic Imaging is a unique series that aims to document the most innovative technologies in all fi elds within diagnostic imaging and interventional radiology, thereby informing the physician in practice of the latest advances in diagnostic imaging and percutaneous imageguided minimally invasive procedures. Th e contents are intended to cover all organs, and all modern imaging techniques and image-guided treatment modalities, with special emphasis on applications in clinical practice. Each volume is a comprehensive reference book on a topical theme, and the editors are always experts of high international standing. Contributions are included from both clinicians and researchers, ensuring wide appeal. Medical Radiology -Radiation Oncology is a unique series that aims to document the most innovative technologies in all fi elds within radiology, thereby informing the physician in practice of the latest advances in diagnostic and treatment techniques. Th e contents range from contemporary statements relating to management for various disease sites to explanations of the newest techniques for tumor identifi cation and of mechanisms for the enhancement of radiation eff ects, with the emphasis on maximizing cure and minimizing complications. Each volume is a comprehensive reference book on a topical theme, and the editors are always experts of high international standing. Contributions are included from both clinicians and researchers, ensuring wide appeal. This work is subject to copyright. All rights are reserved by the Publisher, whether the whole or part of the material is concerned, specifi cally the rights of translation, reprinting, reuse of illustrations, recitation, broadcasting, reproduction on microfi lms or in any other physical way, and transmission or information storage and retrieval, electronic adaptation, computer software, or by similar or dissimilar methodology now known or hereafter developed. The use of general descriptive names, registered names, trademarks, service marks, etc. in this publication does not imply, even in the absence of a specifi c statement, that such names are exempt from the relevant protective laws and regulations and therefore free for general use. The publisher, the authors and the editors are safe to assume that the advice and information in this book are believed to be true and accurate at the date of publication. Neither the publisher nor the authors or the editors give a warranty, express or implied, with respect to the material contained herein or for any errors or omissions that may have been made. AbstractA precise knowledge of antineoplastic drugs is an indispensable basis for the care of patients with cancer. The mechanisms of action and resistance, cross-resistance patterns, pharmacodynamics and pharmacokinetics, pharmacological interaction, and last but not least potential adverse effects should be part of this knowledge. As contemporary cancer care requires interdisciplinary and multiprofessional structures, the radiologist is an important a...

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Review of the efficacy and safety of cryoablation for the treatment of small renal masses

Cited by 13 publications

References 27 publications

Nephron-sparing surgery in multiple renal cancer: a case report

Nephron-sparing surgery in multiple renal cancer: a case report

Arterial Clamping Increases Central Renal Cryoablation Efficacy: An Animal Study

Female Pelvis: Genital Organs

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