Salvage surgery after energy ablation for renal masses

Abstract

ObjectivesTo evaluate the feasibility, safety, pathological, radiological and functional outcomes of salvage surgery after previous renal mass ablation therapy. Patients and MethodsAfter institutional review board approval, we reviewed our renal tumour database, and described the characteristics and outcomes of patients who experienced a local recurrence after energy ablation for renal masses and underwent salvage surgical therapy. ResultsA total of 14 patients fit the inclusion criteria. The median (interquartile range [IQR]) age was 65 (59-77) years, with a median (IQR) Charlson comorbidity index score of 2 (0.75-3.00). Three patients had a solitary kidney. Seven patients received their ablation therapies at an outside institution. Ten patients had undergone percutaneous radiofrequency ablation, three percutaneous cryoablation and one laparoscopic cryoablation. The median (IQR) R.E.N.A.L. nephrometry score at time of surgery was 7 (5-9), while the median (IQR) time from ablation to surgery was 26.5 (16.3-39.3) months. Of the 14 patients, 11 underwent partial nephrectomy and three underwent planned radical nephrectomy. The median (IQR) surgery time was 203 (177-265) min and the median length of stay was 5.5 days. There was one microscopic positive surgical margin. The median tumour size at final pathology was 3.1 cm. In all, 13 patients had renal cell carcinoma and one had no tumour present. Nine were pT1a, 1 pT1b, 2 pT3a, and 1 pT3b tumours. There were four Clavien grade III complications in four patients. The median preoperative estimated glomerular filtration rate (eGFR) and the eGFR at last follow-up were 66 and 66 mL/min/1.73 m 2 . There had been no deaths by the median (IQR) follow-up of 26.5 (10.5-49.5) months. ConclusionsPatients who have undergone previous renal ablation therapy can be salvaged with partial or radical nephrectomy with good intermediate-term outcomes. These procedures may be associated with a high rate of adverse events. Longer follow-up is necessary.

Cryoablation for Small Renal Masses: Selection Criteria, Complications, and Functional and Oncologic Results

“…In an analysis of 337 recurrent CA cases, Long and Park reported a salvage nephrectomy rate of 2.4% [83]. Surgery is complicated by desmoplastic reaction in the perinephric tissue, which has been reported to be more dense after LCA than is observed after failed PCAs or LPN with a higher risk of major complications [34,35].…”

“…The search returned a total of 11 noncomparative CA studies [7][8][9][10][11][12][13][14][15][16][17] and 8 comparative studies (including 2 metaanalyses) comparing CA methods (LCA vs PCA) or CA with other modalities [18][19][20][21][22][23][24][25]. Additional articles were included for assessment of long-term oncologic outcomes [26], functional results [27][28][29][30][31][32], salvage treatment options [33][34][35][36], and cost assessment [37][38][39].…”

Oncological and functional outcomes of salvage renal surgery following failed primary intervention for renal cell carcinoma

“…Dissections are difficult due to distortion of normal anatomical planes and a high rate of pleural injury ( 14 ). Karam et al recently evaluated the feasibility, safety and pathologic, radiologic and functional outcomes of salvage surgery after prior renal mass ablation therapy ( 15 ). They concluded that failed renal ablation therapy can be salvaged with partial or radical nephrectomy with good intermediate outcomes.…”

Ablative Therapies for the Treatment of Small Renal Masses: a Review of Different Modalities and Outcomes

“…In total, 11 patients underwent partial nephrectomy and three underwent radical nephrectomy. One patient had a positive microscopic margin and four patients (29 %) had Clavien grade III complications [46]. Similarly, Jimenez et al published their results of 27 patients requiring salvage nephrectomy (n = 12) or partial nephrectomy (n = 15).…”