Korean J Urol.  2015 Feb;56(2):117-124. 10.4111/kju.2015.56.2.117.

Renal cryoablation of small renal masses: A Korea University experience

• Kim HK
• Pyun JH
• Kim JY
• Kim SB
• Cho S
• Kang SG
• Lee JG
• Kim JJ
• Cheon J
• Kang SH

• KMID: 2133275
• DOI: http://doi.org/10.4111/kju.2015.56.2.117

Abstract

PURPOSE
To evaluate the perioperative, functional, and oncological outcomes of renal cryoablation (RC) of small renal masses (SRMs) performed in Korea University Hospital.
MATERIALS AND METHODS
We reviewed an Institutional Review Board-approved database of 70 patients who underwent RC and were followed up for a minimum of 3 months by a single surgeon in Korea University Hospital from August 2007 to May 2014. Among these patients, 68 patients (79 renal masses) were enrolled in our research. We evaluated perioperative, functional, and oncologic outcomes of RC.
RESULTS
A total of 68 patients (79 renal masses) underwent RC in our institution. The mean age of the patients was 62.0 years. The mean tumor size was 2.25 cm. Among the 59 patients who underwent laparoscopic surgery, only 1 patient (1.47%) was converted to open surgery. No other perioperative complications occurred. The mean preoperative and 1-month postoperative estimated glomerular filtration ratio (eGFR) were 71.8 and 68.3 mL/min/1.73 m2, respectively (p=0.19). The mean 1-year postoperative eGFR was 65.0 mL/min/1.73 m2 (p=0.25). The mean follow-up period was 59.76 months (range, 3-119 months). Local tumor recurrence occurred in eight tumors (15.4%; a total of 52 renal cell carcinomas). Concerning treatment in the patients with recurrence, five patients underwent re-treatment and three patients are under active surveillance. None of the eight patients who experienced local recurrence had additional recurrence or tumor progression during the follow-up period. In our study, the recurrence-free rate was 83.0% and the cancer-specific survival rate was 100%. Moreover, the 5- and 10-year overall survival rates were both 100%.
CONCLUSIONS
Long-term experience with RC in our institution demonstrates that RC is a safe and effective treatment for patients with SRMs.

Keyword

Complementary therapies; Cryosurgery; Kidney neoplasms

MeSH Terms

Adult
Aged
Aged, 80 and over
Biopsy
Carcinoma, Renal Cell/pathology/radiography/*surgery
Cryosurgery/adverse effects/*methods
Follow-Up Studies
Glomerular Filtration Rate
Humans
Kidney Neoplasms/pathology/radiography/*surgery
Laparoscopy/adverse effects/methods
Middle Aged
Neoplasm Recurrence, Local
Tomography, X-Ray Computed
Treatment Outcome
Young Adult

Figure

• 

  Fig. 1 Serial changes of the Von Hippel Lindau (VHL) disease patient. The patient underwent open left partial nephrectomy due to left renal mass on December 2010. (A) The preoperative computed tomography (CT) image showed a 1.7-cm endophytic tumor in right kidney midportion (arrow). (B) The postoperative CT image at 2 weeks. (C) The postoperative CT image at 3 months. The images showed a improved previous cryoablation site in right kidney. (D) The postoperative CT image at 1 year.

• 

  Fig. 2 Serial changes of a left renal tumor in local recurrence patient. (A) The preoperative computed tomography (CT) image showed a 3.7-cm tumor mass in posterior aspect of left kidney midportion. (B) The postoperative CT image at 3 months. (C) The postoperative CT image showed a recurred tumor in medial aspect of cryoablated lesion in left kidney (arrow). (D) The postradiofrequency ablation CT image at 2 months.

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