title: Irreversible electroporation of small renal masses: suboptimal oncologic efficacy in an early series.
abstract: OBJECTIVE
  To report on the first short-term oncologic outcomes of percutaneous irreversible electroporation for small renal masses.
  
  
  METHODS
  Patients with cT1a renal masses treated with irreversible electroporation from April 2013 through December 2016 were reviewed. Small, low complexity tumors were generally selected for irreversible electroporation using the NanoKnife®System (Angiodynamics, Latham, NY, USA). Surveillance imaging was performed post-operatively, and survival analysis was completed using the Kaplan-Meier method.
  
  
  RESULTS
  A total of 42 tumors in 41 patients underwent irreversible electroporation. Mean tumor size was 2.0 cm with a median R.E.N.A.L nephrometry score of 5. Twenty-nine patients (71%) were discharged the same day of the procedure and no major (Clavien grade II or higher) intraoperative or post-operative complications occurred. Initial treatment success rate was 93%; our three failures (7%) underwent salvage radiofrequency ablation. With a mean follow-up of 22 months, 2-year local recurrence-free survival was 83% for patients with biopsy confirmed renal cell carcinoma, 87% with biopsy confirmed or a history of renal cell carcinoma, and 92% for the intent-to-treat cohort.
  
  
  CONCLUSIONS
  Although with low morbidity, in comparison to extirpation and conventional thermal ablation technologies, irreversible electroporation has suboptimal short-term local disease control results in this series of small, low complexity tumors. Larger series and longer follow-up will determine the durability of this modality.
authors.affiliation: Department of Urology, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390-9110, USA.
authors.forename: Noah E
authors.initials: NE
authors.lastname: Canvasser
authors.affiliation: Department of Urology, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390-9110, USA.
authors.forename: Igor
authors.initials: I
authors.lastname: Sorokin
authors.affiliation: Department of Urology, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390-9110, USA.
authors.forename: Aaron H
authors.initials: AH
authors.lastname: Lay
authors.affiliation: Department of Urology, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390-9110, USA.
authors.forename: Monica S C
authors.initials: MSC
authors.lastname: Morgan
authors.affiliation: Department of Urology, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390-9110, USA.
authors.forename: Asim
authors.initials: A
authors.lastname: Ozayar
authors.affiliation: Department of Radiology, University of Texas Southwestern Medical Center, Dallas, TX, USA.
authors.forename: Clayton
authors.initials: C
authors.lastname: Trimmer
authors.affiliation: Department of Urology, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390-9110, USA. jeffrey.cadeddu@utsouthwestern.edu.|Department of Radiology, University of Texas Southwestern Medical Center, Dallas, TX, USA. jeffrey.cadeddu@utsouthwestern.edu.
authors.forename: Jeffrey A
authors.initials: JA
authors.lastname: Cadeddu
mesh_terms: D000368:Aged; D001706:Biopsy / Q000379:methods; D002292:Carcinoma, Renal Cell / Q000473:pathology / Q000628:therapy; D017115:Catheter Ablation / Q000379:methods*; D053672:Electrochemotherapy / Q000009:adverse effects / Q000379:methods; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D007680:Kidney Neoplasms / Q000473:pathology / Q000628:therapy; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000473:pathology; D011183:Postoperative Complications / Q000175:diagnosis*; D019233:Retreatment / Q000379:methods; D014057:Tomography, X-Ray Computed / Q000379:methods; D016896:Treatment Outcome; D047368:Tumor Burden
keywords: Carcinoma; Complications; Electroporation; Kidney neoplasms; Renal cell; Survival rate