Kidney cancer focal cryoablation trend: does location or approach matter?
OBJECTIVE
We evaluated the current indications and surgical and survival outcomes for cryoablation (CA) using either a percutaneous (PCA) or a laparoscopic approach (LCA). We also investigated the ability of the PADUA score to predict the risk of complications and local recurrence.


METHODS
A retrospective analysis was performed at two European tertiary referral centers. Parameters analyzed included size, location, approach, operative time, hospital stay, complications, and functional and oncologic outcomes. Univariate and multivariate analyses were performed. An ROC analysis was conducted to evaluate the accuracy of the PADUA score.


RESULTS
Eighty patients were included. Mean tumor size was 2.6 cm. PCA was more often performed in posterior (95 vs. 60 %), inferior (72 vs. 32 %), and lateral (87 vs. 55 %) tumors. The global complication rate was 8.75 %, although proximity to the renal sinus resulted in a higher rate (30 vs. 4 %). Mean follow-up was 34 and 23 months for LCA and PCA, respectively. The 5-year recurrence-free survival was 76 and 90 % for LCA and PCA, respectively. Multivariate analysis showed that tumor involvement of the collecting system was predictive of recurrence. Under ROC analysis, PADUA score was a mild predictor for complications (AUC = 0.601) and a good predictor for recurrence (AUC = 0.723); PADUA ≥8 was identified as a cutoff for patients to a higher risk of recurrence.


CONCLUSIONS
The percutaneous approach is confirmed to be the preferred CA technique for posterior and lateral tumors. CA in deeper renal lesions and tumors with PADUA score ≥8 might entail a higher risk of recurrence, and closer follow-up should be considered in these patients.
Department of Urology and Radiology, Fundació Puigvert, Barcelona, Spain. orodriguez@fundacio-puigvert.es.
O
O
Rodriguez Faba
King's College Hospital, London, UK.
F
F
Sanguedolce
King's College Hospital, London, UK.
P
P
Grange
King's College Hospital, London, UK.
G
G
Kooiman
Department of Urology, Vilnius University Hospital Santariskiu Klinikos, Vilnius, Lithuania.
A
A
Bakavicius
Department of Urology and Radiology, Fundació Puigvert, Barcelona, Spain.
P
P
De la Torre
Department of Urology and Radiology, Fundació Puigvert, Barcelona, Spain.
J
J
Palou
D000368:Aged; D002292:Carcinoma, Renal Cell / Q000453:epidemiology / Q000601:surgery*; D003452:Cryosurgery / Q000379:methods* / Q000639:trends*; D005260:Female; D006801:Humans; D007680:Kidney Neoplasms / Q000453:epidemiology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology; D012189:Retrospective Studies; D018570:Risk Assessment
Cryoablation; PADUA score; Recurrence; Renal tumors