OBJECTIVES: To evaluate the feasibility, safety, pathologic, radiologic and functional outcomes of salvage surgery after prior renal mass ablation therapy.
PATIENTS AND METHODS: After IRB approval, we reviewed our renal tumor database, and described characteristics and outcomes of patients who experienced a local recurrence after energy ablation for renal masses, and underwent salvage surgical therapy.
RESULTS: Fourteen patients fit the inclusion criteria. Median age was 65 years (IQR 59-77), with median Charlson Comorbidity Index of 2 (IQR 0.75-3.00). Three patients had solitary kidney. Seven patients received their ablation therapies at an outside institution. Ten patients previously underwent percutaneous RFA, 3 percutaneous cryoablation, and 1 laparoscopic cryoablation. Median nephrometry score at time of surgery was 7 (IQR 5-9). Time from ablation to surgery was 26.5 months (IQR 16.3-39.3). Eleven patients underwent partial nephrectomy, and 3 underwent planned radical nephrectomy. Median surgery time was 203 minutes (IQR 177-265). Median length of stay was 5.5 days. There was 1 microscopic positive surgical margin. Median tumor size at final pathology was 3.1 cm. Thirteen patients had RCC and 1 had no tumor present. Nine were pT1a, 1 pT1b, 2 pT3a, and 1 pT3b. There were 4 Clavien grade 3 complications in 4 patients. Median preoperative eGFR and eGFR at last follow-up were 66 and 66 mL/min/1.73 m2. There were no deaths at median follow-up of 26.5 months (IQR 10.5-49.5).
CONCLUSIONS: Patients with prior renal ablation therapy can be salvaged with partial or radical nephrectomy with good intermediate-term outcomes. These procedures may be associated with a high rate of adverse events. Longer follow-up is necessary.
Written by:
Karam JA, Wood CG, Compton ZR, Rao P, Vikram R, Ahrar K, Matin SF. Are you the author?
Department of Urology, The University of Texas MD Anderson Cancer Center, Houston, Texas.
Reference: BJU Int. 2014 Mar 24. Epub ahead of print.
doi: 10.1111/bju.12743
PubMed Abstract
PMID: 24656119
UroToday.com Renal Cancer Section
