Percutaneous cryoablation of kidney cancer under ultrasound and CT navigation

Introduction. Currently, various types of partial nephrectomy are the gold standard for the treatment of early-stage (T1a) renal cell cancer (RCC), but there is a category of patients who cannot undergo surgical procedure under general anesthesia, often due to severe comorbidities. Ablative technologies are an alternative to partial nephrectomy, in particular percutaneous cryoablation (PCA).

Aim. To evaluate the safety and efficiency of PCA of RCC (cT1a) under ultrasound and computed tomography (CT) guidance, as well as overall, disease-free and cancer-specific survival.

Materials and methods. After receiving approval from the local ethics committee, a total of 59 patients with RCC was undergone to PCI at the Institute of Urology and Human Reproductive Health of the First Moscow State Medical University named after I.M. Sechenov. In the period from 2015 to 2017, PCI under ultrasound guidance was performed in 27 patients. The average age of the patients was 66 years (48–83), the average tumor size was 29 mm (14–36). The Charlson comorbidity index was 7 (5–10). In the period from 2018 to 2022, PCI for RCC was performed in 32 patients. The average age was 68 years (46–89), while the average tumor size was 24 mm (8–38). The Charlson comorbidity index was 7 (4–12). The study included patients with histologically confirmed RCC with a tumor size of up to 4 cm.

Results. There were four recurrences diagnosed by ultrasound. Two patients underwent repeated PCI, while in the remaining cases laparoscopic partial nephrectomy was done. Six-year overall, disease-free and cancer-specific survival was 96%, 85% and 100%, respectively. On CT, four relapses were diagnosed. Repeat PCI was done in two patients, and laparoscopic partial nephrectomy was performed in other two cases. In one patient, intraoperative bleeding was noted during the insertion of cryoneedles, due to which the procedure was aborted. Bleeding was stopped conservatively. Three- overall, disease-free and cancer-specific survival was 97%, 88% and 100%, respectively.

Conclusions. PCI under ultrasound and CT guidance showed comparable efficacy in the treatment of RCC, however, to reduce the radiation dose, it is reasonable to use a combination of imaging methods.