title: Efficacy of percutaneous cryoablation of renal cell carcinoma in older patients with medical comorbidities: Outcome study in 70 patients.
abstract: BACKGROUND
  The aim of this study was to establish the efficacy of cryoablation for incidentally discovered small renal cell carcinomas in older patients with medical comorbidities.
  
  
  METHODS
  We carried out a retrospective chart analysis of outcomes of 70 patients treated by cryoablation. The inclusion criteria were age >56 years, medical comorbidities (Charlson class I-III), and suitability for cryoablation established by urologists and interventional radiologists. In total, 43 patients were male, 27 female, and the age range was 56 to 89. The lesions measured 1.5 to 4 cm; 29 were high-grade Fuhrman and 41 were low grade. All lesions were treated by 2 10-minute freezing cycles separated by an 8-minute thawing period. One to seven cryoprobes were inserted according to a preoperative, 3D computed tomography (CT)-based plan.
  
  
  RESULTS
  Results were assessed on follow-up CTs (at 8-9 months). Of the 70 patients, 68 were treated by cryoablations and surgical salvage procedures; these patients were free of disease for 23 to 72 months (mean 39). One patient experienced recurrence and the other was lost to follow-up. One or two cryoablations rendered 66 patients tumour-free and additional surgery rendered another 2 patients tumour-free. The location and configuration of the lesion affected outcomes. Of the 27 posterior lesions, there was 1 failure; of the postero-lateral lesions, there were 4 failures; of the anterior lesions, there were 5 lesions; finally of the 32 central or deep seated lesions, there were 9 failures. Implants with one and two cryoprobes had a high recurrence rate. Three major complications were managed by minor interventions. The mean hospitalization was 1.3 days and the procedure times were variable.
  
  
  CONCLUSIONS
  Percutaneous cryoablation is recommended as a minimally invasive nephron-sparing treatment for amenable lesions in older patients with medical comorbidities.
authors.affiliation: Johns Hopkins Medical Center, Baltimore, MD;
authors.forename: Erich K
authors.initials: EK
authors.lastname: Lang
authors.affiliation: Department of Surgery, Division of Urology, Duke University Medical Center, Durham, NC;
authors.forename: Kan Karl
authors.initials: KK
authors.lastname: Zhang
authors.affiliation: SUNY Downstate Medical Center, Brooklyn, NY.
authors.forename: Quan
authors.initials: Q
authors.lastname: Nguyen
authors.affiliation: SUNY Downstate Medical Center, Brooklyn, NY.
authors.forename: Leann
authors.initials: L
authors.lastname: Myers
authors.affiliation: Johns Hopkins Medical Center, Baltimore, MD;
authors.forename: Mahamed
authors.initials: M
authors.lastname: Allaf
authors.affiliation: SUNY Downstate Medical Center, Brooklyn, NY.
authors.forename: Ivan
authors.initials: I
authors.lastname: Colon