Safety, technical success, and clinical outcomes of percutaneous cryoablation of central renal tumors without pyeloperfusion in 94 patients

Monday, March 6, 2023

3:45 PM – 3:54 PM

Location: Phoenix Convention Center, 221AB

Presenting Author(s)

Richard A. Pigg, BA (he/him/his)

Medical Student
UAB Heersink School of Medicine

Disclosure(s): Boston Scientific: Consultant (), Speaker's Bureau (); Penumbra: Research Grant or Support (); Varian: Consultant (), Research Grant or Support (), Speaker's Bureau ()

Author/Co-author(s)

CS

Cody Savage, BS

Medical student
UAB
RG

Russ Guidry, MD

Resident
UAB
Junjian Huang, MD

Assistant Professor
University of Alabama at Birmingham
Theresa Caridi, MD

Vice Chair and Division Director
University of Alabama At Birmingham
JR

Junaid Raja, M.D., MSPH, M.S.

Assistant Professor
University of Alabama Birmingham
AG

Andrew Gunn, MD

Program Director IR/DR
University of Alabama At Birmingham

Disclosure(s):

Richard A. Pigg, BA: Boston Scientific: Consultant (), Speaker's Bureau (); Penumbra: Research Grant or Support (); Varian: Consultant (), Research Grant or Support (), Speaker's Bureau ()

Theresa Caridi, MD: Boston Scientific: Consultant (Ongoing), Speaking and Teaching (Ongoing); Cook Inc: Speaking and Teaching (Ongoing); PENUMBRA INC: Speaking and Teaching (Terminated); Terumo Medical: Speaking and Teaching (Ongoing); Trisalus Life Sciences: Advisory Committee or Review Panel Member (Ongoing); Varian Interventional Solutions: Speaking and Teaching (Ongoing)

Andrew Gunn, MD: Boston Scientific: Consultant (Ongoing), Speaking and Teaching (Ongoing); Penumbra: Research Grant Recipient (Ongoing); Varian: Consultant (Ongoing), Research Grant Recipient (Ongoing), Speaking and Teaching (Ongoing)

Purpose: To assess the safety, technical success, and clinical outcomes of percutaneous cryoablation (PCA) without pyeloperfusion in 94 patients with central renal tumors.

Materials and Methods: A single center retrospective review of all adult patients with a central renal tumor treated by interventional radiology using PCA without pyeloperfusion was approved by the local IRB. Central tumors were defined as those involving the renal sinus fat on pre-procedural cross-sectional imaging. Patient demographics and baseline tumor characteristics including maximal tumor diameter, tumor stage, RENAL nephrometry score, and distance to the nearest critical structure was recorded. Details of the PCA procedure, primary and secondary technical success, rates of local recurrence, adverse events (AEs), cancer-specific survival (CSS), and overall survival (OS) were compiled. AEs were categorized according to SIR criteria.

Results: 94 patients (48 females (51%); mean age: 68.2 (range:38-87)) with 94 central renal tumors were included. The mean BMI and Charlson co-morbidity index of the cohort were 33.7 (range:20-56) and 6.9 (range:2-12), respectively. Mean maximal tumor diameter, mean RENAL nephrometry score, and mean distance to the nearest critical structure were 37mm (range:15-67), 8 (range:4-11), and 9mm (range:0-29), respectively. 59 tumors (63%) and 35 tumors (37%) were classified as T1a and T1b tumors, respectively. Five patients (5%) underwent embolization of the primary mass prior to PCA. The mean number of probes used during PCA was 2.9 (range:1-8). Primary technical success was achieved in 94% (n=88) of procedures. Of those that did not achieve primary technical success, three underwent successful repeat PCA (secondary technical success: 97%; n=91/94). The other three patients were surveilled for residual disease. 24 patients (26%) required hydrodissection during PCA. Six patients (6%) experienced major AEs after PCA including: hemorrhage requiring embolization (n=3), hemorrhage requiring transfusions with admission (n=2), and perinephric abscess necessitating drain placement (n=1). 22 patients (23%) experienced minor AEs. Nine patients (10%) experienced local recurrence during the follow up period. OS was 94% (n=88/94) while CSS was 98% (n=92/94).

Conclusion: PCA of central renal tumors can achieve high rates of technical and oncologic success with major AE and local recurrence rates comparable to published outcomes of PCA for non-central renal tumors, even without the use of pyeloperfusion.