Pigg Richard A, Raja Junaid Y, Babar Tarik, Li Yufeng, Li Mei, Huang Junjian, Gunn Andrew J
Division of Vascular and Interventional Radiology, University of Alabama at Birmingham, Birmingham, Alabama.
Department of Internal Medicine, University of Alabama at Birmingham, Birmingham, Alabama.
J Vasc Interv Radiol. 2024 Apr;35(4):533-540. doi: 10.1016/j.jvir.2024.01.006. Epub 2024 Jan 12.
To assess the safety and technical success of percutaneous cryoablation (PCA) without pyeloperfusion in 94 patients with central renal tumors.
A retrospective review of all central renal tumors treated by PCA without pyeloperfusion was performed. Central tumors were defined as those involving the renal sinus fat on preprocedural cross-sectional imaging. Patient demographics and baseline tumor characteristics were recorded. The details of the PCA procedure, primary and secondary technical success, rates of local recurrence, adverse events (AEs), cancer-specific survival (CSS), and overall survival (OS) were compiled.
Ninety-four patients (48 females [51%]; mean age, 68.2 years [range, 38-87 years]) with 94 central renal tumors were included. The mean maximal tumor diameter and mean RENAL nephrometry score were 37 mm (range, 15-67 mm) and 8 (range, 4-11), respectively. Primary technical success was achieved in 94% (n = 88) of procedures. Of the patients who did not achieve primary technical success, 3 underwent successful repeat PCA (secondary technical success, 97%; n = 91/94). The other 3 patients were surveilled for residual disease. Twenty-four patients (26%) required hydrodissection during PCA. Six patients (6%) experienced major AEs after PCA including hemorrhage requiring embolization (n = 3), hemorrhage requiring transfusions with admission (n = 2), and perinephric abscess necessitating drain placement (n = 1). Twenty-two patients (23%) experienced minor AEs. Nine patients (10%) experienced local recurrence during the follow-up period. OS was 94% (n = 88/94), whereas CSS was 98% (n = 92/94) during the study follow-up period (mean, 16 months [range, 1-102 months]).
PCA of central renal tumors appears to be safe with high rates of technical success, even without the use of pyeloperfusion.
评估94例中央型肾肿瘤患者在不进行肾盂灌注的情况下经皮冷冻消融术（PCA）的安全性和技术成功率。
对所有接受不进行肾盂灌注的PCA治疗的中央型肾肿瘤患者进行回顾性研究。中央型肿瘤定义为术前横断面成像显示累及肾窦脂肪的肿瘤。记录患者的人口统计学资料和基线肿瘤特征。汇总PCA手术细节、初次和二次技术成功率、局部复发率、不良事件（AE）、癌症特异性生存率（CSS）和总生存率（OS）。
纳入94例患有94个中央型肾肿瘤的患者（48例女性[51%]；平均年龄68.2岁[范围38 - 87岁]）。肿瘤平均最大直径和平均RENAL肾计量评分分别为37 mm（范围15 - 67 mm）和8分（范围4 - 11分）。94%（n = 88）的手术取得了初次技术成功。在未取得初次技术成功的患者中，3例成功接受了重复PCA（二次技术成功，97%；n = 91/94）。另外3例患者接受了残余疾病监测。24例患者（26%）在PCA期间需要进行水分离。6例患者（6%）在PCA后发生了严重AE，包括需要栓塞治疗的出血（n = 3）、入院时需要输血的出血（n = 2）以及需要放置引流管的肾周脓肿（n = 1）。22例患者（23%）发生了轻微AE。9例患者（10%）在随访期间出现局部复发。在研究随访期间（平均16个月[范围1 - 102个月]），OS为94%（n = 88/94），而CSS为98%（n = 92/94）。
即使不使用肾盂灌注，中央型肾肿瘤的PCA似乎也是安全的，技术成功率较高。
