Percutaneous cryoablation of 100 anterior renal tumors: safety, technical success, and clinical outcomes

Monday, March 6, 2023

12:00 PM – 1:00 PM

Location: Phoenix Convention Center, North Ballroom 120 D

Poster Presenter(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)

JR

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

Assistant Professor
University of Alabama Birmingham
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
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) in 100 patients with anterior renal tumors.

Materials and Methods: A single center retrospective analysis of patients with anterior tumors treated with PCA was approved by the local IRB. Anterior tumors were defined as either at or anterior to the level of the renal pelvis on pre-PCA cross-sectional imaging. Summary statistics included patient demographics and baseline tumor attributes. Treatment and follow up metrics included primary and secondary technical success, adverse events (AEs) according to the SIR classification, local recurrence rates, overall survival (OS), and cancer-specific survival (CSS).

Results:

100 patients (60% male; mean age: 63 (range:32-90)) with a mean BMI of 33 (range:19-57) and a mean Charlson comorbidity index of 6 (range: 2-14). The mean maximal tumoral dimension was 29mm (range: 6-662mm). 78 tumors were T1a while 22 were T1b. 32% and 21% of tumors were endophytic and central, respectively.The most common nearest critical structures were bowel (34%), liver (17%), and spleen (5%), and the mean distance to nearest critical structure was 9mm (range:0-40mm). Four patients (4%) had pre-PCA embolization of the primary mass. The mean number of probes during PCA was 2 (range:1-5) with 28% of PCA requiring hydrodissection. Technical success was achieved in 92% of patients. 6/8 patients not achieving primary technical success underwent successful repeat PCA (secondary technical success: 98%). One patient not achieving primary technical success had a benign tumor on pathology obviating treatment and one patient was actively surveilled. Four patients (4%) patients had major AEs (hemorrhage requiring prolonged admission, transfusion, or embolization (n=3), perinephric abscess requiring drainage (n=1)) and 27% had minor AEs. Ten patients (10%) had recurrence in the follow up period with an OS of 91% and CSS of 97%.

Conclusion:

PCA of anterior renal tumors results in high rates of technical and oncologic success with low major AEs and local recurrence rates.