title: Predictors of Complications After Percutaneous Image-Guided Renal Cryoablation for T1a Renal Cortical Neoplasms.
abstract: To determine the incidence and predictors of major complications in patients undergoing percutaneous cryoablation (PCA) for small renal masses.
  
  
  
  We performed a retrospective analysis of patients undergoing PCA from 2005 to 2012. We analyzed demographic, radiographic, and complication data. We defined complications as any deviation from the expected postoperative course. We determined predictors of complications.
  
  
  
  A total of 190 patients were included in the study. The mean age was 69 years, and 132 (69%) were males. The mean tumor diameter was 2.2 cm (0.8-4.0 cm). The mean number of probes utilized per procedure was 2.3. We observed 16 (8.4%) complications including 14 Clavien grade I, which includes 6 (2%) large renal/retroperitoneal hematomas, 4 (2%) pneumothoraxes, 2 (1%) urinary tract infections, and 2 (1%) atrial fibrillations. There were two (1%) Clavien grade II complications (intestinal perforations). In univariable analysis, larger tumors and more probes were associated with higher risk of complications (all ps < 0.05). In multivariable analysis, larger tumor dimension (odds ratio [OR] = 2.85; 95% confidence interval [CI] = 1.34, 6.05; p = 0.006) was independently associated with major complications. After multivariable adjustments for patient's characteristics such as age, gender, American Society of Anesthesiologists, year of surgery, and histopathology, larger tumor dimension (OR = 2.85; 95%CI = 1.34, 6.05; p = 0.006) and more cryoablation probes (OR = 1.94; 95%CI = 1.36, 2.75; p < 0.001) were independently associated with higher risk of major complications.
  
  
  
  In a cohort of patients undergoing PCA for T1a small renal mass, larger tumor dimension and more cryoablation probes were independently associated with higher risk of complication. Although PCA is relatively safe and the major complications are infrequent, careful patient selection is crucial.
authors: 1 Department of Urology, University of California , Irvine, Orange, California.
authors: Zhamshid
authors: Z
authors: Okhunov
authors: 2 Department of Urology, Mayo Clinic , Rochester, Minnesota.
authors: Daniel M
authors: DM
authors: Moreira
authors: 1 Department of Urology, University of California , Irvine, Orange, California.
authors: Michael
authors: M
authors: Del Junco
authors: 1 Department of Urology, University of California , Irvine, Orange, California.
authors: Garen
authors: G
authors: Abedi
authors: 3 The Arthur Smith Institute for Urology , Hofstra North Shore-LIJ School of Medicine, Hempstead, New York.
authors: Igor I
authors: II
authors: Lobko
authors: 1 Department of Urology, University of California , Irvine, Orange, California.
authors: Kamaljot S
authors: KS
authors: Kaler
authors: 1 Department of Urology, University of California , Irvine, Orange, California.
authors: Nobel D
authors: ND
authors: Nguyen
authors: 1 Department of Urology, University of California , Irvine, Orange, California.
authors: Ramy
authors: R
authors: Youssef
authors: 1 Department of Urology, University of California , Irvine, Orange, California.
authors: Edward
authors: E
authors: Uchio
authors: 3 The Arthur Smith Institute for Urology , Hofstra North Shore-LIJ School of Medicine, Hempstead, New York.
authors: Louis R
authors: LR
authors: Kavoussi
authors: 1 Department of Urology, University of California , Irvine, Orange, California.
authors: Jaime
authors: J
authors: Landman
mesh_terms: D000368:Aged; D000465:Algorithms; D003452:Cryosurgery / Q000295:instrumentation* / Q000379:methods*; D005260:Female; D006801:Humans; D015994:Incidence; D007672:Kidney Cortex / Q000473:pathology / Q000601:surgery*; D007680:Kidney Neoplasms / Q000473:pathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome
keywords: complications; cryoablation; image-guided therapies; kidney cancer; renal cell carcinoma; renal cortical neoplasms; small renal masses