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• W2003079009 abstract "No AccessJournal of UrologyAdult Urology1 Apr 2013Percutaneous Renal Cryoablation After Partial Nephrectomy: Technical Feasibility, Complications and Outcomes Ryan M. Hegg, Grant D. Schmit, Stephen A. Boorjian, Robert J. McDonald, A. Nicholas Kurup, Adam J. Weisbrod, Matthew R. Callstrom, Thomas D. Atwell, and R. Houston Thompson Ryan M. HeggRyan M. Hegg Department of Radiology, Mayo Clinic School of Medicine, Rochester, Minnesota More articles by this author , Grant D. SchmitGrant D. Schmit Department of Radiology, Mayo Clinic School of Medicine, Rochester, Minnesota More articles by this author , Stephen A. BoorjianStephen A. Boorjian Department of Urology, Mayo Clinic School of Medicine, Rochester, Minnesota More articles by this author , Robert J. McDonaldRobert J. McDonald Department of Radiology, Mayo Clinic School of Medicine, Rochester, Minnesota More articles by this author , A. Nicholas KurupA. Nicholas Kurup Department of Radiology, Mayo Clinic School of Medicine, Rochester, Minnesota More articles by this author , Adam J. WeisbrodAdam J. Weisbrod Department of Radiology, Mayo Clinic School of Medicine, Rochester, Minnesota More articles by this author , Matthew R. CallstromMatthew R. Callstrom Department of Radiology, Mayo Clinic School of Medicine, Rochester, Minnesota More articles by this author , Thomas D. AtwellThomas D. Atwell Department of Radiology, Mayo Clinic School of Medicine, Rochester, Minnesota More articles by this author , and R. Houston ThompsonR. Houston Thompson Department of Urology, Mayo Clinic School of Medicine, Rochester, Minnesota More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2012.10.066AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract Purpose: Treatment of locally recurrent or de novo tumors in the ipsilateral kidney after partial nephrectomy represents a management dilemma. Percutaneous renal cryoablation offers a minimally invasive treatment option in such cases. We review our single institution experience with percutaneous cryoablation of renal tumors after partial nephrectomy for technical feasibility, complications and outcomes. Materials and Methods: Between March 2003 and January 2012, 48 patients underwent percutaneous cryoablation for the treatment of 68 ipsilateral renal tumors after previous partial nephrectomy. Oncologic outcomes, complications (Clavien-Dindo classification system) and renal function were evaluated. Results: Median maximal diameter of the treated renal tumors was 2.5 cm (range 1.2 to 5.4). All cryoablation procedures were considered technically successful. Of the 54 biopsy proven or suspected renal cell carcinomas with 3 or more months of computerized tomography/magnetic resonance imaging followup after cryoablation (median 19, range 3 to 61), 5 cases (9.3%) had local tumor recurrence. Major (grade 3 or greater) complications developed after 3 (5.7%) cryoablation procedures and there were no perioperative deaths. Median change in patient estimated glomerular filtration rate after renal cryoablation was −1.5 ml per minute. No patients required dialysis in the perioperative period, while 2 with stage 4 chronic kidney disease at the time of ablation became dialysis dependent at 5 and 23 months after treatment, respectively. Conclusions: Percutaneous renal cryoablation after ipsilateral partial nephrectomy is technically feasible, has a low rate of major complications, provides relative preservation of renal function and demonstrates acceptable short-term oncologic outcomes in this challenging population. References 1 : Outcomes following partial nephrectomy by tumor size. J Urol2008; 180: 1912. Link, Google Scholar 2 : Complications of contemporary open nephron sparing surgery: a single institution experience. J Urol2005; 174: 855. Link, Google Scholar 3 : Feasibility and outcomes of repeat partial nephrectomy. J Urol2008; 180: 89. Link, Google Scholar 4 : Repeat partial nephrectomy on the solitary kidney: surgical, functional, and oncologic outcomes. J Urol2010; 183: 1719. Link, Google Scholar 5 : Percutaneous renal cryoablation: experience treating 115 tumors. J Urol2008; 179: 2136. 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Google Scholar 12 : Protecting the ureter during radiofrequency ablation of renal cell cancer: a pilot study of retrograde pyeloperfusion with cooled dextrose 5% in water. J Vasc Interv Radiol2008; 19: 1034. Google Scholar 13 : Image-guided tumor ablation: standardization of terminology and reporting criteria. Radiology2005; 235: 728. Google Scholar 14 : Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg2004; 240: 205. Google Scholar 15 : Assessing kidney function: measured and estimated glomerular filtration rate. N Engl J Med2006; 354: 2473. Google Scholar 16 : Chronic kidney disease after nephrectomy in patients with renal cortical tumours: a retrospective cohort study. Lancet Oncol2006; 7: 735. Google Scholar 17 : Chronic kidney disease and the risks of death, cardiovascular events, and hospitalization. N Engl J Med2004; 351: 1296. Google Scholar 18 : Guideline for management of the clinical T1 renal mass. J Urol2009; 182: 1271. Link, Google Scholar 19 : Analysis of repeat nephron sparing surgery as a treatment option in patients with a solid mass in a renal remnant. J Urol2008; 179: 853. Link, Google Scholar 20 : Complications following 573 percutaneous renal radiofrequency and cryoablation procedures. J Vasc Interv Radiol2012; 23: 48. Google Scholar 21 Schmit GD, Thompson RH, Kurup AN et al: Percutaneous cryoablation of solitary sporadic renal cell carcinomas. BJU Int, Epub ahead of print May 15, 2012. Google Scholar 22 : Prospective analysis of computerized tomography and needle biopsy with permanent sectioning to determine the nature of solid renal masses in adults. J Urol2003; 169: 71. Link, Google Scholar 23 : The accuracy of 250 fine needle biopsies of renal tumors. J Urol2005; 174: 44. Link, Google Scholar 24 : Do percutaneous renal tumor biopsies at initial presentation affect treatment strategies?. Eur Urol2009; 55: 307. Google Scholar © 2013 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetailsCited bySteers W (2013) This Month in Adult UrologyJournal of Urology, VOL. 189, NO. 4, (1181-1182), Online publication date: 1-Apr-2013. Volume 189Issue 4April 2013Page: 1243-1248 Advertisement Copyright & Permissions© 2013 by American Urological Association Education and Research, Inc.Keywordstreatment outcomeablation techniquesoutcome assessmentkidneyMetrics Author Information Ryan M. Hegg Department of Radiology, Mayo Clinic School of Medicine, Rochester, Minnesota More articles by this author Grant D. Schmit Department of Radiology, Mayo Clinic School of Medicine, Rochester, Minnesota More articles by this author Stephen A. Boorjian Department of Urology, Mayo Clinic School of Medicine, Rochester, Minnesota More articles by this author Robert J. McDonald Department of Radiology, Mayo Clinic School of Medicine, Rochester, Minnesota More articles by this author A. Nicholas Kurup Department of Radiology, Mayo Clinic School of Medicine, Rochester, Minnesota More articles by this author Adam J. Weisbrod Department of Radiology, Mayo Clinic School of Medicine, Rochester, Minnesota More articles by this author Matthew R. Callstrom Department of Radiology, Mayo Clinic School of Medicine, Rochester, Minnesota More articles by this author Thomas D. Atwell Department of Radiology, Mayo Clinic School of Medicine, Rochester, Minnesota More articles by this author R. Houston Thompson Department of Urology, Mayo Clinic School of Medicine, Rochester, Minnesota More articles by this author Expand All Advertisement PDF downloadLoading ..." @default.
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