Percutaneous cryoablation and (partial) nephrectomy of small renal tumors

Abstract

Background- In the Netherlands 2700 patients get diagnosed with renal cancer yearly, the typical age is 50-70 years old. The 5-year overall survival for T1(≤7cm) renal carcinoma equals 88%. Amongst treatment options, percutaneous cryoablation(PCA) is associated with less complications and (partial) nephrectomy with better oncologic outcomes.

Methods- Between august 2015 and august 2022 all patients that received primary treatment for a small renal tumor(≤4cm) were included. For the PCA group, repeat interventions were necessary in some cases, those interventions have been included in the analysis of the perioperative complications (CDC <30 days). Oncologic outcomes have been analyzed for patients in follow-up; OS up to 5-years, local and distant recurrence rate.

Results- Total of 455 patients were included, 311 (P)N and 134 in the PCA group. The same number of (P)N’s resulted in 6,4% procedural and 24,8% post-procedural complications. Local and distant recurrence was 1,7% for both and 6 patients in the follow-up are reported dead, none caused by renal cancer. 154 PCA’s were performed, 3,9% procedural and 5,8% post-procedural complications. These patients showed 8,3% local and 6,4% distant recurrence, when correcting for confirmed malignancy this was 9,0% and 10,4%. A total of 9 deaths were reported,6 in the confirmed group, 3 caused by renal cancer.

Conclusion-. The patient selection shows that PCA is performed on older and less healthy patients and with less complications than the (P)N group. Survival for both groups was high with the oncologic outcomes favoring (P)N. These results are in accordance with literature.