Management of residual or recurrent disease following thermal ablation of renal cortical tumors includes surveillance, repeat ablation, or surgical extirpation. We present a multicenter experience with regard to the management of this clinical scenario. Prospectively maintained databases were reviewed to identify 1265 patients who underwent cryoablation (CA) or radiofrequency ablation (RFA) for enhancing renal masses. Disease persistence or recurrence was classified into one of the three categories: (i) residual disease in ablation zone; (ii) recurrence in the ipsilateral renal unit; and (iii) metastatic/extra-renal disease. Seventy seven patients (6.1%) had radiographic evidence of disease persistence or recurrence at a median interval of 13.7 months (range, 1-65 months) post-ablation. Distribution of disease included 47 patients with residual disease in ablation zone, 29 with ipsilateral renal unit recurrences (all in ablation zone), and one with metastatic disease. Fourteen patients (18%) elected for surveillance, and the remaining underwent salvage ablation (n = 50), partial nephrectomy (n = 5), or radical nephrectomy (n = 8). Salvage ablation was successful in 38/50 (76%) patients, with 12 failures managed by observation (3), tertiary ablation (6), and radical nephrectomy (3). At a median follow-up of 28 months, the actuarial cancer-specific survival and overall survival in this select cohort of patients was 94.8 and 89.6%, respectively.

BACKGROUND AND PURPOSE Surgical management of a renal neoplasm in a solitary kidney is a balance between oncologic control and preservation of renal function. We analyzed patients with a renal mass in a solitary kidney undergoing nephron-sparing procedures to determine perioperative, oncologic, and renal functional outcomes. PATIENTS AND METHODS A multicenter study was performed from 12 institutions. All patients with a functional or anatomic solitary kidney who underwent nephron-sparing surgery for one or more renal masses were included. Tumor size, complications, and recurrence rates were recorded. Renal function was assessed with serum creatinine level and estimated glomerular filtration rate. RESULTS Ninety-eight patients underwent 105 ablations, and 100 patients underwent partial nephrectomy (PN). Preoperative estimated glomerular filtration rate (eGFR) was similar between the groups. Tumors managed with PN were significantly larger than those managed with ablation (P<0.001). Ablations were associated with a lower overall complication rate (9.5% vs 24%, P=0.01) and higher local recurrence rate (6.7% vs 3%, P=0.04). Eighty-four patients had a preoperative eGFR ≥60 mL/min/1.73 m(2). Among these patients, 19 (23%) fell below this threshold after 3 months and 15 (18%) at 12 months. Postoperatively, there was no significant difference in eGFR between the groups. CONCLUSIONS Extirpation and ablation are both reasonable options for treatment. Ablation is more minimally invasive, albeit with higher recurrence rates compared with PN. Postoperative renal function is similar in both groups and is not affected by surgical approach.

You have accessJournal of UrologyKidney Cancer: Localized1 Apr 20111523 MANAGEMENT OF RECURRENCES FOLLOWING CRYOABLATION OR RADIOFREQUENCY ABLATION (RFA) OF RENAL CORTICAL TUMORS Jay Raman, Chester Donnally, W. Bruce Shingleton, Daniel Kaplon, Stephen Nakada, David Werle, Joseph Pettus, Ronald Zagoria, Ali Ordonez, Jaime Landman, Amin Herati, Benjamin Lee, Kamran Ahrar, Surena Matin, Charles Moore, Raymond Leveillee, Michael Louie, Ralph Clayman, and Jeffrey Cadeddu Jay RamanJay Raman Hershey, PA More articles by this author , Chester DonnallyChester Donnally Dallas, TX More articles by this author , W. Bruce ShingletonW. Bruce Shingleton Chapel Hill, NC More articles by this author , Daniel KaplonDaniel Kaplon Madison, WI More articles by this author , Stephen NakadaStephen Nakada Madison, WI More articles by this author , David WerleDavid Werle Winston Salem, NC More articles by this author , Joseph PettusJoseph Pettus Winston Salem, NC More articles by this author , Ronald ZagoriaRonald Zagoria Winston Salem, NC More articles by this author , Ali OrdonezAli Ordonez New York, NY More articles by this author , Jaime LandmanJaime Landman New York, NY More articles by this author , Amin HeratiAmin Herati Long Island, NY More articles by this author , Benjamin LeeBenjamin Lee Long Island, NY More articles by this author , Kamran AhrarKamran Ahrar Houston, TX More articles by this author , Surena MatinSurena Matin Houston, TX More articles by this author , Charles MooreCharles Moore Miami, FL More articles by this author , Raymond LeveilleeRaymond Leveillee Miami, FL More articles by this author , Michael LouieMichael Louie Irvine, CA More articles by this author , Ralph ClaymanRalph Clayman Irvine, CA More articles by this author , and Jeffrey CadedduJeffrey Cadeddu Dallas, TX More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2011.02.1516AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Thermal ablation has assumed a role in the management of renal masses. Recurrences are reported to occur in 5–10% of cases. Management options for these recurrences are incompletely defined and include surveillance, repeat ablation, or surgical extirpation. We present a multi-institutional experience for management of recurrences following renal ablation. METHODS Prospectively maintained databases from 9 centers were reviewed to identify 1265 patients (with 1385 renal tumors) who underwent cryoablation or radiofrequency ablation (RFA). Ablation was performed via laparoscopic or percutaneous approaches. Recurrences were classified into one of 3 categories: 1) incomplete primary ablation (<3 months from initial ablation); 2) ablation zone recurrence; and 3) metastatic/distant/extra-renal disease. RESULTS Overall, 77 patients (6.1%) developed a radiographic recurrence at a mean interval of 13.7 months (range, 1–65) post-ablation. Recurrence rates were 6.6% (58/875) for RFA and 4.9% (19/390) for cryoablation (p=0.22). For patients with recurrences, mean pre-ablation lesion size was 3.3cm and two-thirds of these tumors were endophytic. The distribution of initial ablation recurrences included 47 incomplete primary ablations, 29 ablation zone recurrences, and 1 metastasis. Management is highlighted in the figure. In the 16 patients requiring surgical extirpation, final pathology was renal cell carcinoma (RCC) in 10, necrosis/fibrosis in 4, oncocytoma in 1, and AML in 1. Of the 10 RCC specimens, histological subtype was 8 clear cell and 2 papillary with a stage distribution of pT1a in 7 and pT3a in 3. At mean of 28.0 months (range, 3 to 69), 53 patients had no evidence of disease, 16 were alive with disease, 4 had died of metastatic RCC, and 4 died of other causes. The actuarial cancer-specific and overall survival in this select cohort of patients was 94.8% and 89.6%, respectively, at last follow-up. CONCLUSIONS Recurrent disease following thermal ablation occurred in 6% of cases. Salvage ablative procedures successfully managed recurrences in 41 of 77 (53%) cases. Nonetheless, approximately 20% of patients with renal recurrences required extirpative surgery. Delineation of management strategies for recurrent disease allows for better patient counseling prior to primary ablation therapy. © 2011 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 185Issue 4SApril 2011Page: e611 Advertisement Copyright & Permissions© 2011 by American Urological Association Education and Research, Inc.MetricsAuthor Information Jay Raman Hershey, PA More articles by this author Chester Donnally Dallas, TX More articles by this author W. Bruce Shingleton Chapel Hill, NC More articles by this author Daniel Kaplon Madison, WI More articles by this author Stephen Nakada Madison, WI More articles by this author David Werle Winston Salem, NC More articles by this author Joseph Pettus Winston Salem, NC More articles by this author Ronald Zagoria Winston Salem, NC More articles by this author Ali Ordonez New York, NY More articles by this author Jaime Landman New York, NY More articles by this author Amin Herati Long Island, NY More articles by this author Benjamin Lee Long Island, NY More articles by this author Kamran Ahrar Houston, TX More articles by this author Surena Matin Houston, TX More articles by this author Charles Moore Miami, FL More articles by this author Raymond Leveillee Miami, FL More articles by this author Michael Louie Irvine, CA More articles by this author Ralph Clayman Irvine, CA More articles by this author Jeffrey Cadeddu Dallas, TX More articles by this author Expand All Advertisement Advertisement PDF DownloadLoading ...

Purpose: We reviewed our experience with laparoscopic cryoablation (LCA) and percutaneous cryoablation (PCA) in the management of small renal tumors and compared clinical outcomes, short-term oncologic results, and patient complications. Patients and Methods: A retrospective comparison of two prospectively collected oncologic databases was performed. Ninety patients underwent PCA for 99 lesions and 81 patients underwent an LCA for 97 lesions. Patient characteristics, perioperative data, and tumor characteristics were recorded including age, estimated blood loss, complication rate, tumor size, and tumor pathology. Results: Patients in both the PCA and LCA groups had similar demographic and tumor characteristics. The PCA group had two major complications (2%), and the LCA group had three major complications (3.7%) (P = 0.374). In the LCA group, estimated blood loss was associated with tumor location with hilar tumor demonstrating a significantly higher mean blood loss (191 mL) compared with endophytic, mesophytic, and exophytic tumors (70 mL, 71 mL, 73.5 mL), respectively (P = 0.05). Malignancies rated in the PCA and LCA groups were 50.5% and 60.0%, respectively (P < 0.05). In the PCA group, nine (9.1%) patients demonstrated treatment failure with a persistent enhancement in the ablation bed. All nine were treated with a subsequent PCA. One patient had subsequent tumor bed enhancement and underwent an open radical nephrectomy. Treatment failed in three (3.1%) patients in the LCA cohort (incomplete ablation or recurrence). Conclusions: With short-term follow-up, both LCA and PCA are safe and effective treatments for small renal masses. Patients undergoing PCA had a reduced hospital stay and a lower surgical complication rate, albeit with an elevated re-treatment rate. Long-term data is needed to establish long-term oncologic efficacy. Renal function did not significantly change in patients after cryoablation, including patients with a solitary kidney.

OBJECTIVES To determine the feasibility and safety of performing percutaneous cryoablation of angiomyolipomas (AMLs) in patients with solitary kidneys.METHODS Three patients with AMLs involving a solitary kidney underwent computed tomography-guided percutaneous cryoablation. All lesions were located in the lateral/posterior part of the kidney, allowing for safe access from the skin for cryoprobe insertion. Intravenous sedation and local anesthesia were used for each patient. Follow-up computed tomography or magnetic resonance imaging and physical examination, urinalysis, and serum blood urea nitrogen/creatinine measurement were performed to evaluate for lesion recurrence and to evaluate the safety profile.RESULTS Three tumors (1.2-2.5 cm) were treated. The patients experienced minimal to no pain during percutaneous cryoablation, and all were discharged the same day. No procedural or postoperative complications were noted. During the follow-up period (5-36 months), the first 2 patients had no radiographic evidence of recurrence. Initial follow-up imaging of the third patient displayed persistent AMLs.CONCLUSIONS A review of the published data suggested the necessity to prophylactically treat AMLs of solitary kidneys. In this series, percutaneous cryoablation proved a safe and effective method for treating these lesions. This ultimately provides a minimally invasive option for similar patients, potentially avoiding an open surgical procedure or the risk of hemorrhage. UROLOGY 74: 1246-1249, 2009. (C) 2009 Elsevier Inc.

You have accessJournal of UrologyModerated Poster 39, Tuesday, May 22, 2007, 10:00 am - 12:00 pm1 Apr 20071299: Efficacy and Complications of Cryoablation for Renal Masses; Percutaneous VS. Laparoscopic Ablation Jaime Landman, Daniel S. Lehman, Gregory W. Hruby, Courtney K. Phillips, and Bruce Shingleton Jaime LandmanJaime Landman More articles by this author , Daniel S. LehmanDaniel S. Lehman More articles by this author , Gregory W. HrubyGregory W. Hruby More articles by this author , Courtney K. PhillipsCourtney K. Phillips More articles by this author , and Bruce ShingletonBruce Shingleton More articles by this author View All Author Informationhttps://doi.org/10.1016/S0022-5347(18)31513-1AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail "1299: Efficacy and Complications of Cryoablation for Renal Masses; Percutaneous VS. Laparoscopic Ablation." The Journal of Urology, 177(4S), pp. 427–428 © 2016 by American Urological AssociationFiguresReferencesRelatedDetails Volume 177Issue 4SApril 2007Page: 427-428 Advertisement Copyright & Permissions© 2016 by American Urological AssociationMetricsAuthor Information Jaime Landman More articles by this author Daniel S. Lehman More articles by this author Gregory W. Hruby More articles by this author Courtney K. Phillips More articles by this author Bruce Shingleton More articles by this author Expand All Advertisement PDF downloadLoading ...

Needle ablative therapies for small incidental renal masses are emerging as alternatives to traditional extirpative surgery. Reasons include their associated decreased morbidity, shorter convalescence, and the ability to avert the higher risk of extirpative surgery in an aging patient population. Cryoablation (CA) and radiofrequency ablation are the two most thoroughly studied needle ablative methods used for renal cancer. High-intensity focused ultrasound has also been studied but with limited published human experience at this time. For both radiofrequency ablation and CA, in vitro experiments, animal studies, and (increasingly) human experience have been published, allowing us to define appropriate candidates for such therapies, their oncologic outcomes, and the potential pitfalls. While long-term data is being collected, the current literature suggests that CA and radiofrequency ablation can be safely performed and can effectively eradicate small renal cancers with cancer-specific survival rates similar to those of traditional surgical options.

As new minimally invasive treatment options for small renal tumors such as laparoscopic partial nephrectomy (LPN), radiofrequency ablation (RFA), and cryoablation(CA) have been developed, the reliance upon imaging technologies, both intraoperatively and postoperatively, has expanded greatly. CT, MRI, and ultrasonography (US)have proven themselves extremely useful in this regard, but their utility requires a thorough understanding of each modality's limitations, proper intraoperative use, and expected postoperative findings. This article discusses intraoperative use of US for LPN,RFA, and CA. The expected postoperative MRI and CT findings after CA and RFA also are covered, highlighting the different radiographic evolutionary patterns encountered after use of these technologies. Because the success of these new treatments for small re-nal tumors (especially RFA and CA) depends not only on the technology itself but also on the advantages and limitations of the associated radiographic techniques, urologists of the 21st century must be facile at interpreting and manipulating these imaging modalities to appropriately care for their renal tumor patients.

You have accessJournal of UrologyPodium, Tuesday, May 24, 2005, 3:30 - 5:30 pm1 Apr 20051402: Evaluation of 3-D Ultrasonography for Image Guided Percutaneous Renal Cryoablation W. Bruce Shingleton and Thomas Siskron W. Bruce ShingletonW. Bruce Shingleton More articles by this author and Thomas SiskronThomas Siskron More articles by this author View All Author Informationhttps://doi.org/10.1016/S0022-5347(18)35536-8AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail "1402: Evaluation of 3-D Ultrasonography for Image Guided Percutaneous Renal Cryoablation." The Journal of Urology, 173(4S), p. 380 © 2016 by American Urological AssociationFiguresReferencesRelatedDetails Volume 173Issue 4SApril 2005Page: 380 Advertisement Copyright & Permissions© 2016 by American Urological AssociationMetricsAuthor Information W. Bruce Shingleton More articles by this author Thomas Siskron More articles by this author Expand All Advertisement PDF downloadLoading ...