Cryoablation of renal cell carcinoma: six-year experience with 64 cases

Objective To summarize our clinical experience of cryoablation for renal cancer and to analyze the therapeutic indication, security, selection of cryoablation and outcomes. Methods Sixty-four patients suffered with T1a renal cell carcinoma were enrolled in this study from March 2012 to March 2018. Among them, 5 cases were senile patients(≥80 years), 5 cases complicated with other cancers, 3 cases complicated with renal insufficiency, 4 cases complicated with decompensated cirrhosis, 3 cases with bilateral renal cancer, 4 cases with solitary kidney cancer and 39 cases with some other complications. The preoperative serum creatinine level was(80.5±38.2)μmol/L. The patients underwent laparoscopic single-site (LESS) renal cryoablation, conventional laparoscopic renal cryoablation, or percutaneous image-guided cryoablation according to individual situation. Contrast-enhanced CT scan or MRI were used during the procedures and follow-up was performed. Results All operations were completed successfully and technical success was achieved as well in all cases. Blood transfusion was necessary for 2 cases because of hemorrhage.The mean diameter of the mass was (2.6±0.90)cm , the median volume of blood loss was 50ml(10-110 ml), and the mean operation time was(96.0±24.5)min. The median inpatient hospital stay was 3 d(1-6 d). In one case, digital subtraction angiography(DSA )embolization was performed due to hemorrhage after surgery. None of the other cases had intraoperative or postoperative complications. The serum creatinine level after surgery was not significantly decreased [postoperative (83.8±42.1) μmol/L, P=0.64]. The contrast-enhanced CT or MRI of the kidneys one week postoperatively showed uniform low density in all lesion areas, which represented complete ablation and regression of the tumor. All cases were followed up regularly. One case showed relapse at the 6th month follow-up and underwent cryoablation again. Another case, who was not regularly followed up, relapsed at 69th month after surgery. No relapse was observed in the other cases during the follow-up. Conclusions Renal cancer cryoablation is a safe, feasible and efficacious therapy for the patients who suffered from unresectable T1a renal cell carcinoma because of high surgical risk or multifocal lesions. Key words: Carcinoma, renal cell; Cryoablation; Laparoscopy; Imaging-guided