Surgical cryoablation as an option for small renal masses in patients who are not ideal partial nephrectomy candidates: intermediate-term outcomes

Authors

  • Venu Chalasani Division of Urology, University of Western Ontario, London, ON
  • Carlos H. Martinez Division of Urology, University of Western Ontario, London, ON
  • Darwin Lim Division of Urology, University of Western Ontario, London, ON
  • Mazen Abdelhady Division of Urology, University of Western Ontario, London, ON
  • Joseph L. Chin Division of Urology, University of Western Ontario, London, ON

DOI:

https://doi.org/10.5489/cuaj.954

Abstract

Objective: There has been increasing interest in surveillance and
ablative techniques for small renal masses (SRM), given the increasing
number being diagnosed at smaller sizes. Of the currently available
ablative techniques, radiofrequency ablation and cryoablation
have been the popular ones. We describe our intermediate-term
outcomes with using cryoablation for SRM in patients who were
not ideal candidates for partial nephrectomy.

Materials and methods: Nineteen patients treated with cryoablation
were included. Patients with renal lesions <4 cm were considered
for cryoablation, and all patients were treated between 2002 and
2007. Access was either laparoscopic (transperitoneal) or via open
surgical techniques. From 2002 to 2004, the CryoCare System
(Endocare, Inc., Irvine, CA) was used, with probe sizes ranging
from 3 to 5 mm. Before 2004, the SeedNet system (Galil Medical,
Arden Hills, MN) was used, with 17-gauge (1.47 mm) IceRod cryoneedles.
Recurrence-free survival (RFS) and overall survival (OS)
were calculated using Kaplan Meier methodology.

Results: The mean age was 56.7 years. The mean tumour size was
2.6 cm (range 1.2-4.0 cm). There were no intraoperative or postoperative
complications in the 19 patients. One patient has been
lost to follow-up; mean follow up was 41.6 months (range 7-84
months) in the cohort. Recurrence, defined as either increase in
size of lesion or enhancement on follow-up imaging, was seen in
4 patients. There was 1 non-cancer specific death, and 1 cancer
specific death.

Conclusions: The 4-year RFS rate and OS rate were 83.6% and
94.1%, respectively, in patients with SRM who were unsuitable
for partial nephrectomy.

Objectif : Le diagnostic étant de plus en plus précoce, on note un
intérêt croissant pour les techniques de surveillance et d’ablation
des petites masses rénales. Parmi les techniques actuelles, l’ablation
par radiofréquence et la cryoablation sont les plus utilisées. Nous
présentons ici nos résultats à moyen terme avec la cryoablation
de petites masses rénales chez des patients à qui la néphrectomie
partielle ne convenait pas.

Matériel et méthodologie : Dix-neuf patients traités par cryoablation
ont été inclus. Les patients présentant des lésions rénales de < 4 cm
étaient considérés, et tous les patients ont été traités entre 2002 et
2007. L’abord se faisait par laparoscopie (transpéritonéale) ou par
chirurgie ouverte. De 2002 à 2004, on a eu recours au système
CryoCare (Endocare, Inc., Irvine, Calif.), avec des sondes de 3 à
5 mm. Avant 2004, on utilisait le système SeedNetMC (Galil Medical,
Arden Hills, Minn.), avec des cryo-aiguilles IceRod de calibre 17
(1,47 mm). Les taux de survie sans récurrence (SSR) et de survie
globale (SG) ont été calculés par la méthode de Kaplan Meier.

Résultats : L’âge moyen était de 56,7 ans; la taille moyenne des
tumeurs était de 2,6 cm (de 1,2 à 4,0 cm). Aucun des 19 patients
n’a présenté de complication intra ou postopératoire. Un patient a
été perdu de vue lors du suivi. La durée moyenne du suivi était de
41,6 mois (7 à 84 mois). Quatre patients ont présenté une récurrence,
définie comme une augmentation de la taille de la lésion
ou une lésion plus visible lors des épreuves d’imagerie de suivi.
Un patient est décédé de causes non liées au cancer, et un autre,
des suites du cancer.

Conclusions : Les taux de SSR et de SG après 4 ans étaient de
83,6 % et de 94,1 %, respectivement, chez des patients avec
petites masses rénales à qui une néphrectomie partielle ne convenait
pas.

Downloads

Download data is not yet available.

Author Biographies

Venu Chalasani, Division of Urology, University of Western Ontario, London, ON

Carlos H. Martinez, Division of Urology, University of Western Ontario, London, ON

Darwin Lim, Division of Urology, University of Western Ontario, London, ON

Mazen Abdelhady, Division of Urology, University of Western Ontario, London, ON

Joseph L. Chin, Division of Urology, University of Western Ontario, London, ON

Downloads

How to Cite

Chalasani, V., Martinez, C. H., Lim, D., Abdelhady, M., & Chin, J. L. (2013). Surgical cryoablation as an option for small renal masses in patients who are not ideal partial nephrectomy candidates: intermediate-term outcomes. Canadian Urological Association Journal, 4(6), 399–402. https://doi.org/10.5489/cuaj.954

Issue

Vol. 4 No. 6 (2010): CUAJ December

Section

Original Research

License

You, the Author(s), assign your copyright in and to the Article to the Canadian Urological Association. This means that you may not, without the prior written permission of the CUA:

  • Post the Article on any Web site
  • Translate or authorize a translation of the Article
  • Copy or otherwise reproduce the Article, in any format, beyond what is permitted under Canadian copyright law, or authorize others to do so
  • Copy or otherwise reproduce portions of the Article, including tables and figures, beyond what is permitted under Canadian copyright law, or authorize others to do so.

The CUA encourages use for non-commercial educational purposes and will not unreasonably deny any such permission request.

You retain your moral rights in and to the Article. This means that the CUA may not assert its copyright in such a way that would negatively reflect on your reputation or your right to be associated with the Article.

The CUA also requires you to warrant the following:

  • That you are the Author(s) and sole owner(s), that the Article is original and unpublished and that you have not previously assigned copyright or granted a licence to any other third party;
  • That all individuals who have made a substantive contribution to the article are acknowledged;
  • That the Article does not infringe any proprietary right of any third party and that you have received the permissions necessary to include the work of others in the Article; and
  • That the Article does not libel or violate the privacy rights of any third party.