Background and Objectives: To assess efficacy and safety of Percutaneous Cryoablation (PCA) of small renal masses (SRMs) using Trifecta outcomes in a large cohort of patients who were not eligible for surgery. Materials and methods: All PCAs performed in four different centers between September 2009 and September 2019 were retrospectively evaluated. Patients were divided in two different groups depending on masses dimensional criteria: Group-A: diameter ≤ 25 mm and Group-B: diameter > 25 mm. Complications rates were reported and classified according to the Clavien-Dindo system. The estimate glomerular filtration rate (eGFR) was calculated before PCA and during follow-up schedule. Every patient received a Contrast Enhanced Ultrasound (CEUS) evaluation on the first postoperative day. Radiological follow-up was taken at 3, 6, and 12 months for the first year, then yearly. Radiological recurrence was defined as a contrast enhancement persistence and was reported in the study. Finally, Trifecta outcome, which included complications, RFS, and preservation of eGFR class, was calculated for every procedure at a median follow-up of 32 months. Results: The median age of the patients was 74 years. Group-A included 200 procedures while Group-B included 140. Seventy-eight patients were eligible for Trifecta evaluation. Trifecta was achieved in 69.6% of procedures in Group-A, 40.6% in Group-B (p = 0.02). We observed an increased rate of complication in Group-B (13.0% vs. 28.6; p < 0.001). However, 97.5% were <II Clavien-Dindo grade. No differences were found between the two groups regarding eGFR before and after treatment. Further, 24-months RFS rates were respectively 98.0% for Group-A and 92.1% in Group-B, while at 36 months were respectively 94.5% and 87.5% (p = 0.08). Conclusions: PCA seems to be a safe and effective treatment for SRM but in the need of more strict dimensional criteria to achieve a higher possible success rate.
Medicina (Kaunas, Lithuania). 2022 Aug 03*** epublish ***
Andrea Piasentin, Francesco Claps, Tommaso Silvestri, Giacomo Rebez, Fabio Traunero, Maria Carmen Mir, Michele Rizzo, Antonio Celia, Calogero Cicero, Martina Urbani, Luca Balestreri, Lisa Pola, Fulvio Laganà, Stefano Cernic, Maria Assunta Cova, Michele Bertolotto, Carlo Trombetta, Giovanni Liguori, Nicola Pavan
Urology Clinic, Department of Medical, Surgical and Health Sciences, University of Trieste, Cattinara Hospital, Strada di Fiume 447, 34149 Trieste, Italy., Department of Urology, San Bassiano Hospital, 36061 Bassano del Grappa, Italy., Department of Urology, Fundacion Instituto Valenciano Oncologia, FIVO, 46009 Valencia, Spain., Radiology Department, San Bassiano Hospital, ULSS 7 Pedemontana, 36061 Bassano del Grappa, Italy., Radiology Department, Centro di Riferimento Oncologico (CRO), 33081 Aviano, Italy., Department of Urology, ULSS 3 Serenissima, 30031 Dolo, Italy., Radiology Department, Azienda Universitaria Giuliano Isontina (ASUGI), Università degli Studi di Trieste, 34127 Trieste, Italy.